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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No, <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no, explain : <br /> el e c S 5 PVH 1y �f <br /> Describe septic installation to be installed: <br /> Z. WATER SUPPLY / <br /> Is water supplied by private well : Yes ✓ iso_ Is well proper: <br /> Yes= No_ State deficiency: <br /> Does existing or porpoeed use make this well public water: Yes <br /> No 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: < �� 54� : ,.-+• - 0 5;� <br /> Potential problem: a-- ^ s -= <br /> 4 . ELY, MOSQUITO OR V TOR PO'rCNTIAL <br /> State possible vector potential Pt necessary control: <br /> J <br /> 5 . TO .FT/BATH FAC T .S <br /> No . ek location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPLRATION HISTORY <br /> 7 . GENERAL SANITATI N <br /> State any problems not previously noted : <br /> 3 . POPU .AT Ot7 D .NSTTY <br /> APpx . No . People per eq . mi . <br />