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1 . SEWAGE <br /> Distance to Public SewersConnection necessary: Yes Nolt/_ <br /> Does existi septic syste comply with Ord. #549 : Yes No— <br /> Unknown <br /> o_ <br /> Unknown=f no, explain: <br /> Describe septic installation to be installed: <br /> 6T rL-'9 <br /> VfL <br /> 2 . WATER SUPPLY / <br /> Is water supplied by private well : Yes ✓ No Is well proper: <br /> Yes No State deficiency: <br /> Does e sting or purposed use make this well puic water: Yes <br /> No V 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: nlryke <br /> 4 . M__ nrjTTO OR VECTOR POTENTIAL <br /> State pos able vector potential & necessary contro <br /> 5 . C' ^ <br /> No. & location exist g: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problemsof previously note <br /> 3 . POPULATION D <br /> Appx. No . P ople per sq. mi . <br />