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i . SERE <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 /> n=ay -- - jllation to be installed: <br /> 2 . WATER SUPPL`.t <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : -- <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments Z/. o---( '�7 <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY„ MQSQUITO OR y � p I'TNTIAL <br /> State possible vector potential. & necessary control.- <br /> 5 . <br /> ontrol:5 . TOILET/BATH FACILITES <br /> No. & location existing: --_ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HIS nRY <br /> f4, <br /> 44 ot <br /> 7 . GENERAL SANITA MN. <br /> State any problems not; previously noted: . _ <br /> S . FQPULATIQN DENSIT- <br /> Appx. No. People per sq. mi .- _ <br />