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I <br /> SEWAGF <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 /> ► ' �,�, -�� SSU 11 l�ti� � . <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No_�L Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: `les <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> U, <br /> 3 . GARBAGE AGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . EILL.- MOSQUITQ OR V ^.TQ E2rrLzAL1 <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . pgEyIOUS OPERATION HISTO,;, <br /> a�ti� vac` (.4JlJ w�_ <br /> 7 . GENERAL SAP11! `ISN <br /> State any problems not previously noted:- <br /> 8 . <br /> oted:_s . POPU ATIO14 DENSITY <br /> Y <br /> Appx. No . People per rq. mi . <br /> /117 l� l D ZS <br /> w� �� <br />