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1. :;�tiJA(1F (?) <br /> Distance to "ublic Sewers Connection necessary: Yes _ No <br /> Does exiseptic sys <br /> If iplaitem oomp y with Ord. #549: Yes No Unknown <br /> Describe septic installation to be installed: <br /> Additional information or coaaaente: <br /> 2. WATER SUPFLY <br /> IQ water supplied by private well: Yes llo Ia well proper: Yea No <br /> S,t�" deficiency: _ —'" —*— — <br /> Does existing or proposed use make this well public water: Yea _ No <br /> Sample of well water taken: Yes No _ Date Taken Results <br /> Additional information or comments: <br /> 3. LGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No _'Service Area'No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY. MOSQUITO OR VECTOR tOlINTIAL <br /> State possible vector potential & necessary control: <br /> 5 . AIR PO Lf,U T I Ii:: i'O Z"c11 TI A i. , <br /> "aLe posSio_e burnlnC or NroceJsin� I,ul1uLanLs & necessary control: <br /> 6. TOILET/IlAni FACILITIES <br /> No. do location existing: Additional facilities needed <br /> 7. 1'Itr.'V10U:) U� ;'IIOId III; f:,i(Y <br /> b. GE1 EIr AL SA1,i A"iIUtJ <br /> S to Lu arty I,rob lems nut j,rc v l()u:,lyO <br /> Ij <br /> 9. POPULATION DENSITY <br /> Appx. iJo. I-eople per sq. mi . <br />