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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 /> Describe septic installation to be installed: !°Efdit�i <br /> 2 . MATER SUEUZL <br /> Is water supplied by private well :. YesN Is ell proper: <br /> Yes No State deficiency: �����.✓ a� �" f*/�Y <br /> �lff'��;,�•• T•,. fe�i,t!,C;'•/�Ca�.��'/'.r':,'��,i'!•v1^`�v%f:t.r.a. E��! ?/l�F F2'/�!L9�.f•7'J,.Ce�1/ <br /> Does existing or porposed use make tl;is well public/water: Yes-4— <br /> No Sample of well water taken: Yes No Date t ke�r <br /> Results Additional information or comments �/f��f�� <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes o re Service ANQ. <br /> Other proposed disposal method: <br /> �� <br /> Potential problem- <br /> 4 . <br /> roblem- <br /> 4 . =I- MOSQUITO OF y11-7 ) E-CL' UETIAL <br /> State possible vector potential & necessary control - <br /> 5 . <br /> ontrol :5 . TQILET/BATH FACILI7T <br /> No . & location existing : __ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATIONH=��RY <br /> 7 . GENERAL SANIZf, Zj' a <br /> State any problems not previously noted: <br /> 8 . POPULATIQ14 DENSITY <br /> A p p x . No . P e o p 1 e per sq . m1.. <br />