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ala/ U G,` T C nz . /&, u.a <br /> N' tl e/d �re.M.,'S <br /> � . <br /> SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> S <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes_ No— <br /> �� State deficiency :_ <br /> Does existing or porposed use make- this well public water: Yes <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R . US . <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposaj method: <br /> Potential problem : C/ G- <br /> 4 . <br /> G 4 . FILI. MOSQUITO OR VZ^.TQ Psr=1ALL <br /> State passible vector potential AA necessary control: <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed —_ <br /> 6 . PRRVTOOSOPER.ATION H=5 = <br /> 7 . GENERAL SAtaTTATION <br /> State any problems rot previously noted: - <br /> 8 . <br /> oted: _9 . POPULATION DENSTTX <br /> Appx . No . People per aq. mi . <br />