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1 . SEWAGE <br /> Distance to Public Sewers /�� Connection necessary : Yes No . <br /> Does existing septic system comply with Ord . 0549 : Yeses No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY """ e Ivry. �✓,Cc' <br /> Is water supplied by private well : Yes No Is viell proper: <br /> Yeses No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> No�X 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 /> 4 . Fes. MOSQUITO OR VZ".TO ZC)ME_IAL <br /> State possible vector potentiFtl necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existin : Additional <br /> facilities needed <br /> 6 . PREVTOT72 OPERATION HISTORY <br /> %��'.Q/�d��Fi-erg_ — O,CDu�,����/7 �clF✓ <br /> 7 . GENERAL SAIL1 '1,� '3 O <br /> State any problem: not previously noted: <br /> 8 . POPULATION DENSITY. <br /> Appx. No . People per sq . mi . <br />