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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: <br /> Describe septic installation to be installed: Alf�V 1)1 4 1 fe-10�;T <br /> 2 . WATER SUPPLY <br /> Is water supplied by private ;cell : Yes ✓ No Is well proper: <br /> Yes_ LZ No State deficiency : <br /> Does existing or porposed use make this well put�,lic 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 . FLY. MOSQUITO OR y ) 'SME TIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILETZBATH_ L'ACILI7la <br /> No . & location existing: __. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISMEX <br /> 7 . GENERAL SANITr3II01. <br /> State any problems not previously noted: ._ _ <br /> 8 . POPULATIQN -Mi l-IY <br /> Appx. No. People per sq. mi . - _ <br />