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1 . SEWAGE cn.0 <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain ! <br /> � r G7,14 o ZZ Ce Are <br /> / e <br /> Deec vepti in llation to be itis a le / S <br /> J <br /> 2 . WATER SUPPLY A IX - � 3 .3761 <br /> Is water supplied by private well: Yes � No Is well roper: <br /> Yes No 't ut <br /> Does existing or porposed use make this well public water: Yes <br /> Nom_ Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR Y +^. ) '-CMUNTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILITFa _ <br /> No . & location existing : Additional <br /> facilities needed_^ <br /> 6 . PREVIOUS OPERATION H=D <br /> 7 <br /> AL �iS <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : _ <br /> 3 . POPULATIDN DEiJ=y <br /> Appx , No . People per sq. mi . _ <br />