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1 7 EWAGa E <br /> Distance to Public Sewers rJv ,G'Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. #549 : Yes No <br /> Unknown If no, explain:/ —' <br /> Describe septic installation to be installed: /y�-`� <br /> /l�d�/SFR oFl�F���F 1lf <br /> 2 . HATER SUPPLY <br /> Is water supplied by private well : Yes N/ Is well proper: <br /> Yes No State deficiency - <br /> Does <br /> eficiency :Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes Nom Date taken <br /> Results � Additional information or comments <br /> �/Z �/l,��C"o�/..�i'�1dcTe� �'✓.i/��f�,��� i®�����.0/c l��C�F F.� <br /> 3 . GIARBAGE & R . TTU <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed dispo l method: <br /> Potential roblem: --f® .r �� O�/�rol .A <br /> 4 . ELY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control : ��: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS QPERATION HISTORY <br /> 7 . CLENERAL SANITATTCN <br /> State any problems not previously rioted : <br /> 3 . POPULATION DENSITY <br /> Appx . No . People per sq . mi . <br />