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I. SEWAGE <br /> Distance to Public Sewers * //� M'l-e Connection necessary: Yes No ✓ <br /> Does existing septic system comply with Ord. 9549. Yes No <br /> /Jo -e-VC rx-F+.a S.'c -h'cs dlti C.,-'k , <br /> //e r <br /> Describe septic installation to be installed. T S.tcd AW fo /SS4tyrrG40— <br /> of <br /> 2 WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: <br /> Does existingr proposed ma this well public water: Yes�No Sample of well <br /> water taken: o ✓ Date taken ^)/,+ Results -J/,4 <br /> Additional information or comments: G <br /> / o da use <br /> ..r. -rae, 4� w.%/ lie Q ASC <br /> 3. GARBAGE & REFUSE <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 /> L/I . ,Eyaaas <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> Appx. number of people per square mile <br />