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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 's <br /> Unknown If no, explain: <br /> Descr be s � <br /> tic gins a latio`ri- to b� installed: <br /> � L�'L Ct3 d+ "'� f ,ri�► ski <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes No_2L- Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No 'y Sample of well water taken: Yes_ Nom` Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: M <br /> 4. FLY- MQSQUITQ OR VZ^.TOR PO'j'J�H IA , <br /> State possible vector potential & necessary control : <br /> 5 . TOTLET/BATH FACILE TES nrri t Additional <br /> No. & location existing: <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> r�u� �Lr �t`v Guar Edi� 9fi'7wn.e <br /> 7 . GENERAL SANITATION- <br /> State any problems not previously noted : <br /> S . POPULATION DENiSTTY <br /> Appx. No . People per eq. mi . <br />