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1. SEWAGE <br /> Distance to Public Sewers _% Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. #549 : Yes No_. <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: - <br /> 2 . WATER SUPPLY <br /> Is water suppliedby private well: Yes No A," 6s wel� prop r: <br /> Yes N0_4 St to deficiency: <br /> �✓ <br /> c�✓�,� � •� e�r/c �'G/%q e; �.�i/f T.et.l9 �e�1' .d G' o-/E 9�1-�':Gi.s�Ea �./�.G /r <br /> m1.�l�d.�J�/y0�/✓rte /c�G�C �'��4/F•Cl iy�✓fd: 9.P��fA,C.9��',�.�i/.�e�f.��F�' <br /> ��2'ffi�'o C'��6 Elf�-���'�.�� it o F e o�/� �y`.6E-.r���/�07,�f6��.[i�.✓J <br /> Does existing or porposed use make this well public Water: Yes <br /> No Sample of well water taken: Yes NoDate taken <br /> Re ul s Additlonal i4,forjoation or comments �F� Fi <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELLY-L MOSQUITO OR V C..TO E i'EENTIAL <br /> State possible vector potentiftl necessary control:�� <br /> 5 . TOILET/BATH EACILI ES <br /> No. & location existing. Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTO <br /> R <br /> 7 . GENERAL SANTT '1,19 'ION <br /> State any problems not previously noted: <br /> 3 . POPULATION DRiISM <br /> Appx. No . People per sq. mi . <br />