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1 SEWAGE <br /> Distance to Public Sewers N��° Connection recess aJy: Yes No <br /> Does existing septic system comply with Ord. #549: Yes / No <br /> Describe septic installation to be installed: r u k ✓moi,... <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes ✓ No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes_ No Sample of well <br /> water taken: Yes_ No Date taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -'� No _ Service Area No. <br /> Other proposed disposal method: Aa.o <br /> Potential problems: -Vta-"+ /wry <br /> 4. FLY, MOSQUITO, OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: ( " <br /> 5. TOILET/BATH FACILITIES <br /> No. & location existing: Nrr <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: nuTtip <br /> 8 POPULATION DENSITY <br /> Appx_ number of people per square mile ti�� <br />