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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . #549 : Yes— No_ <br /> Unknown If no, explain: <br /> S nT <br /> Describe septic installation to be installed: <br /> Z. WATER SUPPLY <br /> Is w t-er supplied by private well : Yes /No_ Is well proper: <br /> Yes_ No_ State deficiency : p <br /> ✓�li�l1a�"ry�j. <br /> Does existing or porposed use make this wel�puubb wateYes <br /> No Sample of well water taken: Yes_ No Date taken <br /> Results Additiona�in , r at ion Qr.comments <br /> /lac jod'^ A ��?.2 ,5-,�y � ??CGr6 1 T <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . ELY , MOSQUITO OR-1 zC)PENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed__ <br /> 6 . PREVIOUS OPERATION HIST <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No. People per sq. mi ._ <br />