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1 . SEWAGE <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: L <br /> 4,n r 0 0d4 <br /> C1 <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No . Is well proper: <br /> Yes— No State deficiency : _— <br /> It� � �v�� P G'C hQlj ✓r-U n�✓c.nC 2 <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 & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =L r1OSOUITO OR_Y 'i- M=, ' IL <br /> State possible vector potentirtl & necessary control : <br /> 5 . TQILET/BATH FACILI7T <br /> No. & location exiting: Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITALUM <br /> State any problems' ilot previously noted - -- <br /> 8 . <br /> oted : —S . POP TULATIQN DEHSIT; <br /> Appx. No . People per sq. mi . -^ _ <br />