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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 /> Unknown I,,-- If no, explain: <br /> No Aeeoao aoa.fee" ' <br /> Describe septic installation to 'be installed: MN-t5 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ✓ No Is Drell proper: <br /> Yes No ✓ State deficiency:C - Nn �^- <br /> c!�h in. <br /> Does existing or porposed use make this well public Water: Yes <br /> No "- Sample of well water tarsen: 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: neo n� <br /> Potential problem- <br /> 4 . FILL,- MOSQUITQ OB V M^TC) PS>METIf L <br /> State possible vector potentiFtl & necessary control : <br /> /SON 6 <br /> 5 . TQIl ET/BATH FACILITES <br /> No. & location existing : Additional <br /> facilities needed _ <br /> 6 . PRFVT0QS O ERATION HISTORY- <br /> 7 . <br /> ISTORY7 . GENERAL SAI I'r '1, 21_01 <br /> State any problems not previously noted : <br /> 8 . POPULATION DENSITY <br /> Appx. No . People per sq. mi . <br />