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1. SEWAGE <br /> Distance to Public Sewers > I^ - Connection necessary: Yes_ No <br /> Does existing septic system comply with Ord. #549 : Yes_ Noi/ <br /> Unknown If no, explain: <br /> /ye �Kc --7 -Lt4C Sy / <br /> Describe se tic in!gtallation to ' installed: _7 <br /> 6 a xrL f�� <br /> p-{- QvrS�(rm�.-f �af �e nip a� aL fzr wr' Sau e0� f>• <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing o p4*pos�ed sc make this well pu�].ic water: Yes <br /> No Sample 0;�r —xater taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 0. /JCU)S <br /> 3 . GARRAGR & REPOSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: �e - <br /> 4. FLY. MOSQUITO OR VRCTOR POTENTTAL <br /> State possible vectorlyyt,�entiftl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: �� Additional <br /> facilities needed <br /> 6 . PRRVIOOS OPRRATTON HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9 . POPULATION DRNSTTY <br /> APpx. No. People per aq. mi. r� w <br />