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1. SEWAGE <br /> Distance to Public Sewers Connection necessaa : Yes No ✓ <br /> Does existing septic s�vstem comply with Ord. 9549: Yes ✓ No <br /> Describe septic installation to be installed: A-)oxe <br /> 2. R'ATER SUPPLY <br /> Is water supplied by private well: Yes �No Is well proper: Yes No <br /> State deficiency: <br /> Does existing or proposed use in a this well public water: Yes _ No Sample of well <br /> water taken: Yes _ No _/Date taken �A Results A)1A <br /> Additional information or comments: .,4du�iv/?9 4 a&. x-7 f_Ki -J, <br /> So *7• j.,f....4� <br /> 3. GARBAGE & REFUSE a/d oL�r <br /> Licensed scavenger pick-up: Yes �No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problems <br /> 4. FLY. MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7 GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> Appx. number of people per square mile <br />