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Ile- <br /> / b �/ y T P � ,� /�►.,,, ham.--� �`' S <br /> � . SEWAGE <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 . MATER SUPPLE <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 Date taken <br /> Results Additional information or comments <br /> T of <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, MOSQUITOFL-Y I0 DLCL'LMIAL <br /> State possible vector potentihl ne,:;essary control : <br /> 5 . TQILET/ ATH FACILI7 <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 1 <br /> 7 . GENERAL SANI'&,'ION <br /> State any problems not previously noted : _ <br /> 8 . FOPULATIQJJ Jj .NSIT_Y_ <br /> Appx. No . People per sq . mi .-- <br /> _-__ <br />