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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 /> Des rib®`septEioc instal at�ioontheins lled: <br /> 2. MATER SUPPLY \//`- <br /> Is water supplied. by private we'll • Yes L�t1o*-- Is we 1 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�Datpe + ker) <br /> Resullts Additional information or comments �c� ��� <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. MOSQUITQ OR VE^,TC) EC,'r ,NTIAL <br /> State possible vector potentit,l & necessary control: <br /> 5 . TQILET/BATH FCTU ' .S <br /> No. & location existing:.�"� _ Additional <br /> facilities needed <br /> 6. PREVTOT72 OPERATION HISTORY <br /> 7 . CEN RAL SAPTIT '1,A 'ION <br /> State any problems not previously noted: <br /> 8 . ROPULATIO14 DENSITY <br /> Appx. No. People per sq. <br />