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r <br /> 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: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No IS 1 proper: <br /> Yes No State deficiency : .rc�.,✓� .GF <br /> .�./F�l/%�6 �y��.o���.����.�Fr�i iia✓/.�i���f <br /> Does existing or purposed use make this well pub is water: Yes <br /> No Sample of well water taken- Yes NoDate talon <br /> ReJult8 Additional information or <br /> eel' <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No No. <br /> Other proposed disposal method <br /> Potential problem: <br /> 4 . ZYL MOSQUITO OR Y ' ZC)LEjTjAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILETIBATH FACILI7TS <br /> No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=_U <br /> 7 . GENERAL SANI'TA'112U. <br /> State any problems not previously noted- <br /> 8 . POP LATIQ14 DEtj=_Y <br /> Appx . No . People per sq. mi. <br />