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1 . SEWAGE <br /> Distance to Public Sewers '� Connection necessary: Yes Nolz__ <br /> Does existi g septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installation.'- to be installed: <br /> +'f-J� C rG ✓ <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes v" No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> ►� o Sample of well water taken: Yes No_ Date taken <br /> Results // Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scaveng pick-up: Yes No Service Area No. <br /> Other proposed dis . osal method - <br /> Potential proble ,: <br /> 4 . FLY, MOSQUITO OR—M,', PO'TENTIAL <br /> State possible vector po 71 tial & necess y control : <br /> 7 <br /> 5 . TQILET/BATH FACILI`3'T <br /> No . & location existing : _ _ Additional <br /> facilities needed <br /> 6 . PREVIQUa OPERATION H_IaTfM <br /> 7 . GENERAL SANI',ATION <br /> State any problems, not previous l_y rioted- --\ <br /> 8 . FQPULATIQN DENSIT-1 <br /> Appx . No . People per sq. mi . ._ <br />