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1 . SEWAGEIsm. <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: <br /> � � j � .i2: <br /> 2 . WATER SUPPLY <br /> Is water,- supplied by private well : Yes 1� No Is well proper: <br /> Yes _ State deficiency : <br /> Does existing or porposed use make this we'll public water: Yes <br /> No 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: <br /> 4. ELLYL MQSQUITO MLY C^ ) � Z2r=1A.L <br /> State possible vector potentittl & necessary control: <br /> 5 . TQI ,LET/BATH FACIL,I�T <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> � y <br /> 7 . GENERAL SANIULT-QN <br /> State any problems not previously noted: _ _ <br /> 3 . POPULATION DENSITY <br /> Appx. No. People per sq. mi ._ �`� <br />