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x <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No1C-- <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown <br /> If no, explain: <br /> �i�'cff I`/F,G� �'J �� t'/Fil��,l�.f !/�,rer ��y�sr ��a�e'1�s.c �✓•!e�'„r4,v ' <br /> Describe septic installation o be installed: �i��.f���-� .ef <br /> o <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes .2!�., No Is well proper: <br /> Yes„ No State deficiency: <br /> Does xisting 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 /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No_z� Service .Area No. <br /> Other proposed disposal method: <br /> � <br /> Potential problem: <br /> 4. ML. MOSQUITO OR U y ECUENTIAL <br /> State possible vector potential & necessary control:-O' <br /> 5 . TOILETIBATH FACILOla <br /> No . & location existing: %''' Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> C- <br /> 7 . GENERAL SANI'T.19 'I01N <br /> State any problems not previously noted: <br /> 8 . POPULATIQN DENSITY ��� ✓� �� <br /> Appx. No . People per sq. mi . <br />