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1 . SEWAGE <br /> Distance to Public Sewers l 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 /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is wel proper: <br /> Yes No State deficiency -- >.����c4y�y_," W. ;4r- a <br /> Does existing or porposed 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 ervice Area No . <br /> Other proposed disposal method: - C f-9�� 6 <br /> Potential problem : <br /> 4 . FILL. MOSQUITO OR =CMMEMIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILI7 S <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITAT-I-QU <br /> State any problems not previously noted: <br /> 8 . POPULATIQN DUSITY ��//� <br /> Appx . No . People per sq. mi l <br />