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1 . SEWAGE / <br /> Distance to Public Sewers _�_ Connection necessary : Yes_ No_ <br /> Does existing septic system' 9 omp1 �wit Ord . 0549 : Yes— No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: 9� <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No_ Is well proper: <br /> Ye'�s/�--2�,- No_ State deficiency: <br /> dif-0 <br /> ecn�/!/!°E x'11 �Qr' ; �� :r aJ%�c > dX O ,t/1 <br /> Does existing or porpoeed use make tills well public water: Yes— <br /> No -< <br /> lesNo_< Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO ORV_r.Oa POTENTTAt <br /> State possible vector potential & necessary control: <br /> 5 . TOILFT/BATH FACILITES <br /> No. ek location existing: IP"i-te Additional <br /> facilities needed <br /> 6. PRgyTnns OPERATION HISTngy <br /> 7 . GENERAL SANITATTON <br /> State any problems not previously noted: -90+"F - <br /> 9 . POPULATION DENSTTY <br /> APpx . No. People per sq. mi .��'c� <br />