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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes- " No— <br /> Unk�jnown If no, explain: <br /> tT -77- 'f52 ,7?`76-4, ?7- 11135 +-71/- '- Oq, 7'f-S39 2291St 69G'77g-753 <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <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: es 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 /> 4 . ELI, MOSGDUITO QE Y FLI-RLI©L <br /> State possible vector potentifal & necessary control : <br /> 5 . TQTLET/BATH F CILITEa <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERA ION =21 <br /> i <br /> 7 . GENERAL SANITAU-0. <br /> State any problems not previously noted: — _ <br /> 3 . �OPULATIa� UE11SIT1 <br /> Appx. No . People per sq. mi .-�_ _ <br />