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1SEWAGE <br /> Distance to Public Sewers i— connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. 11549 : Yes. No_ <br /> Unknown If no, explain: <br /> Describe septiQ installation to 'be installed: v*'L <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes-. No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No_,&- Sample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments o�E�oE rte r �.GL <br /> o / �11 ." <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes-k- No Service Area No. <br /> Other proposed disposal met�od: <br /> Potentia]. problem: <br /> 4. FLY. MOSOUTTO OR y LTCj� SP1 i�TIAL <br /> State possible vector potentiFtl 8.c necessary control: <br /> 5. TQILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRFVTons OPERAlIoN HTsTnRY <br /> Me/�y/,/�fE�r//✓E,G G'..;✓�,r�y� >�i'a�//" a ii�/J�� �l <br /> 7 -!fa�tf�' �.Ce �E✓✓/-J/6 �/�C�fi��s //✓f�if�i'!cis�-G0 6�'1/� 'd�'�'C�/�' „'�/_ ��7✓ .00 I!//J�i�.lol�,/ <br /> �dt.�E.✓'� 04/� lb e <br /> �9d f•Q9 c F2 ��s.lc2 �C�/,�o�/ <br /> 7 . GENERAL SANTTATION <br /> State any problems not previously noted <br /> S . POPULA TnN DFH,'jTTY <br /> APpx. No. People per seq. mi._ �,��s�dl�d.�F -.F'E✓�of.�'��, <br />