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1 . SEWAGE 1 ' <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 /> 'T o,J I �0 It'101-`(- '5 �P_ �_-j <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No V Is dell proper: <br /> Yes No State deficiency : A)11:+ <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 <br /> �-, 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> L-� 4. ZLJL MOSQUITO OR VZ•'T-o pS)TTjjTIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATFI FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> !_.' 6 . PREVTOfla rPI R.,A'i Inn • S.T <br /> V <br /> 7 . Q N RA , SAPJIT TION <br /> State any problems nat previously noted .- - lie" <br /> 8 . F'_OF'ULATIOtd hr i 'T " 9 <br /> Appx. No . People per sq. mi . <br />