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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 9544: Yes No <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPLY Po� ��er/ol <br /> �- <br /> Is water supplied by private well: Yes_�� No Is well proper: Yes 4,,= 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 A Results <br /> idi'io" <br /> al�nformation or comments: 6 <br /> 3. ARBAGE & REFUSL � <br /> Licensed sc :_ s----, y , <br /> Other proposed- ' osa method: <br /> Potential roblems: f GvG/1 .t•� <br /> 4. FLY, MOS R� TIAL <br /> ate possible vector p,& necessary control: <br /> t <br /> 5. TOILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> Ll <br /> /. <br /> 7. GENERAL SANITATION #• /'� i� <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> Appx. number of people per square mile <br /> �"�7 � �,-,, t,�' ✓ rte-, �J 1''�.-1 � T" 1�d � <br /> .fie��.•, r .� � �� ��.r � <br />