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1 SEWAGE <br /> Distance to Public Sewers ""�Connection necessary: Yes No�C <br /> Does existing septic system comply with Ord . #549 : Yes No— <br /> Unknown V If no, explain: <br /> e, <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes �L_ No Is well proper: <br /> Yes-X_ No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes2, <br /> No Sample of well water taken: Yes No < Date taken <br /> Results Additional information or comments <br /> // <br /> 4L Lo <br /> 3 . GARBAGE & REFUSE <br /> Licensed segvenger pick-up: Yes No Service Area No . <br /> Other propos d disposal method: <br /> Potential prem: <br /> 4 . =L MOSQUITO QB' yE^TO aC)f ,EjjAL <br /> State possible vetgtor potentiftl control : <br /> 5 . Tri ET/ ATH FACILITES <br /> No . & location existing : X Additional <br /> facilities needed _ <br /> 6 . PREVIOQ2 OPERATION o R <br /> 7 . GENERAL SAT T O <br /> State any problems not previously noted: -- <br /> 3 . <br /> oted: _3 . RnpuLATIOi; DaiIsITY <br /> Appx. No . People per sq . mi . <br />