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1 . SEWAGE AP <br /> Distance to Public Sewers Connection necessary: Yes No_✓ <br /> Does exist ng septic syste comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic inptal ation/ to e installed: <br /> o L-e `S r 2z'—j <br /> 2 . WATER SUPPLY <br /> Is wa r supplied by private well : Yes No Is well proper: <br /> Yes VNo State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No v Sample of well water -taken: Yes No - Date taken <br /> Results Additional information <br /> or comments <br /> /Qrive we l/ /0 ca�f.X <br /> cavt&fi�_( <br /> 3 . GARBAGE & REFUSE <br /> . Lice ed scavenger pick-up: Yes No Service Area No. <br /> Other roposed disposal method: <br /> Potents 1 problem: <br /> 4 . FLYTO OR r! ' )rj;1 NT IAL <br /> State possi 1e vector potential & necessary contrgl:: <br /> / , <br /> 5 . TQILET/BMLEA_(21 <br /> No. & location exis ng: — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPER TION HIST�i <br /> 7 . GENERAL SANITA;}'ION. <br /> State any problems of previously ted: -_ <br /> S . POPULATIO14 Dz. �SITY <br /> Appx. No . J •ople per sq. mi . <br />