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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 If no, explain: / <br /> /7 <br /> Desc�,ibe septic nstal at on t be nstalled: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well% Yes tio_ I well pr9�er <br /> Yes— Nom State deficiency: ,- - <br /> i• �s1'c �✓ <br /> Does existing or porposed use make this well public water: Yes <br /> No__4Sample of well water taken: Yes_ No-4 Date t ken <br /> Results Additional information or comments f-Gy 2z'--o <br /> 3 . GARBAGE & R .FUSS <br /> Licensed scavenger pick-up: Yeses No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: e�/rf/� _ <br /> 4 . ELY MOSQUITO OR VOR V CTO ECP_UjTIAjl <br /> State possible vector potential & necessary control: 1 , 4r? <br /> 5 . ZOTLFT/� BAH FAC7LLTar <br /> No . & location existing : ! sr — Additional <br /> facilities needed —_ <br /> 6 . PRFVTONS OPERATION HISTORY <br /> 7 . GENERAL SAtITTPA1,TON <br /> State any problems not previously noted: <br /> 8 . PO I ATION1Ei T jT Y <br /> APpx . No . People per sq. mi .- <br />