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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-::L'- <br /> Unknown -If no, explain: <br /> �d K rS"f7^4 .C N)74 L �r.' ::;L%44 S <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPL`I car % <br /> Is wF�er supplied by private well : Yes :/ clo Is well proper: <br /> Yes - No State deficiency: <br /> Does�xisting or porposed use rnake this well pu lic Water: Yes <br /> No Sample of well water tarsen: Yes No - Date taken <br /> Results Additional information or comments <br /> 1 <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No rvice Area No . <br /> Other proposed disposal method: <br /> Potential p oblem: <br /> 4 . E,^.TO ps'f aLT_TAL• <br /> State possible vector potential necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PRFyIni],_ OPERATION HS M <br /> 7 . GENERAL SAP�ITATJON <br /> State any problem: not previously noted : _ <br /> 8 . POPULATION DEN ST11 <br /> Apex . No. People per rq . mi . <br />