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. f <br /> 1 . SEWAGE - <br /> Distance to Public Sewers Connection necessary: Yes jj <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> r .r <br /> rn7 d /!? .� G G Gid Q zi7'L � <br /> Describe septicnsallation to 'be installed: Afl <br /> JO <br /> 2 . WATER SUPPLTI <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <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: 777:--- - <br /> Potential problem: <br /> 4 . �L MOSQUITO QR V QTO <br /> State possible vector potentiFtl Fz necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTO <br /> 7 . GENERAL SA1jj Ajj-()N <br /> State any problems not previously noted - - <br /> 8 . <br /> oted : _8 . POPULATIO14 DENSITY <br /> Appx . No . People per rq. rni . <br />