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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_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed : <br /> Z . WATER SUPPLY <br /> Is water supplied by private well : Yes ' <br /> well p op$r: <br /> Yes_ No_ State deficiency !�2l�Gg��`� ���� �s' '.yam �lOGLr <br /> Does existing or porposed use make- this well public water: Yes <br /> Nom_ Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RR TSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No : <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLYS MOSQUITO OR YECTOR PO'f 'NI_ TIAL, <br /> State possible vector potentit,l & necessary control : <br /> 5 . TOT /BATH FACILITES <br /> No . & location existing : i%� Additional <br /> facilities needed — <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 9,E/1/lal�.fE <br /> 7 . GENERAL SANT'A'1'ION <br /> State any problems not previously noted: <br /> 8 . POPULATIQU - iMa,SITY <br /> Appx . No . People per sq. mi . <br />