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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 IE no, explain : <br /> Describe septic installation to be installed: <br /> C Al C7 <br /> 2 . WATFR SUPPLY <br /> Is wate_r supplied by private well : Yes No_ Is well proper: <br /> Yes_,,, No State deficiency: <br /> Does existing or porposed use make this well public water: 'les <br /> Noe Sample of wel'. water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RRFUSF <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:__ <br /> 4 . F .Y . MOSQUITO OR V RCTOR PO' <br /> State possible vector potentirtl & necessary control: <br /> 5 . TOILET/HATH FACILITF.a <br /> No . & location existing: Additional <br /> facilities needed_ <br /> 6 . PRRVIOUS opgRATION HTsTORY <br /> r 11 f S 2 �. P / <br /> S S ,►' �.�.-� �..--�... -rr� /iii• "'e y% <br /> 66 aj � <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9 . POPULATION DF.:4STTY <br /> A/pppxx. No. People per eq. mi. / <br /> /LX / � �� rGt Z rs I el I'1t A:+ .l�j <br /> zfe 5 c <br />