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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord . #549 : Yeses No_ <br /> Unknown If no, explain: -G. <br /> oy-- _ � // � �� -✓pro o�y- _ <br /> Describe septic installation to be installed: 6�� <br /> 2 . WATER SUPPL`I <br /> Is water supplied by private well : Yes ' No_ Is well proper: <br /> Yee, No_ State deficiency : <br /> Does existing or porposed use make this well public water: Yee <br /> No Sample of well water taken: Yes_ No Date taken <br /> Results Additionalnformation or comments <br /> F9�� 4✓�� c�./a tdFG <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . ELY. MOSQUITO OR V FOTO PSLTTNTTAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATTON HTSTORY <br /> 7 . GENERAL SANITATION <br /> State any problems riot previously noted: <br /> 9 . PO tJ ,AT i N DENSTTX <br /> Appx. No . People per sn . mi . 6��«��� �f✓����79� <br />