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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes NqL <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: KOA A� <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes X No Is well proper: <br /> Yes / No__ State deficiency: <br /> Does, existing or purposed use make this wellp blic water: Yes <br /> No Sample of well water taken: Yes NOT Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes X- No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY1- MOSQUITO OR V I^ ) ECi'TENTIAL <br /> State possible vector potential. & necessary control. N <br /> 5 . TOILET/BATH F a=M <br /> No. & location existing: /Vl� Additional <br /> facilities needed <br /> 6 . PREVIOUS CPERATION HISTC'i <br /> f01 <br /> 7 . GENERAL SANITA'I'ZS)J. <br /> State any probleWs not previously noted:_ _ <br /> 3 . POPULATIQN DENSIT-1 <br /> Appx. No. People per sq. mi. <br />