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-� � � ' S'r+� 1 Kf f -G�vr• 4�I !-!r�-M/1 J� �.10`� 11.Ir��� f . � � <br /> �•� {,a�•(•• lota�t d o++ ��a�4aLcd �a�c.c•���,rr( F <br /> r <br /> 1. SEWAGE <br /> s <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No <br /> fe-VAA _4 <br /> Describe septic installation to be installed: tee._ <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 publi water: Yes No ✓Sample of well <br /> water taken: Yes No Date taken A Results SIA <br /> Additional information or comments: A)a _uerr ov,!Afe •„ „ <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problems: <br /> 4. FLY, MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH FACILITIES i <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> b <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted.- <br /> 8. <br /> oted:8. POPULATION DENSITY <br /> Appx. number of people per square mile <br />