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e � <br /> 1 . SEWAGE JV 0---"- <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Dattaken <br /> Results Additional information or comments ��t/' e 7 <br /> c� n-11 04e�� 7"Li�ztea <br /> 3 . GARBAGE & REFUSE 2 rC-� #�_ <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . EL1. MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential. & necessary control : <br /> 5 . TQILET/BATH FCILI'1'ES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTQRY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted- - <br /> 8 . <br /> oted: ._S . P s P Ur, TIQN DENSITY <br /> Appx. No. People per sq. mi ._ <br />