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i <br /> 1 . SEWAGE l � <br /> Distance to Public Sewers N Connection necessary: Yes No <br /> Does exist ng septic system comply with Ord . #549 : Yes No— <br /> Unknown <br /> �// If no, explain : G <br /> /f L- r� na re/c a.-c// e�, S e��jCS <br /> OG.7.�✓ C/U n 3 �J/2 Ct/Q G(JO.-�i�� <br /> Describe septic installation too be installed: - <br /> 2 . <br /> nstalled:Z . MATER SUPPLY , <br /> Is wat r supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency - <br /> Does existing or porposed use make this well ptb is water: Yes <br /> No ✓ Sample of well water taken: Yes No �/ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAG REFUSE <br /> . Licensed avenger pick-up: Yes No Ser ice Area No. <br /> Other propo ed disposal method: <br /> Potential pro lem: <br /> 4 . FLY,- MOSQUITO OR PC)L=AL <br /> State possible ve for patentitd & r ,cessFiry control: <br /> 5 . TQILET/BATH FACILI71a <br /> No. & location existing ., Additional <br /> facilities needed <br /> — <br /> 6 . PREVIOUS QPERATIOjj HTST/Ry <br /> 7 n i <br /> State any pro lems not previously noted _ <br /> 8 . POPU 14 D1 !J iIT_vL <br /> Appx. No . People per sq. mi ._ <br />