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1 . SEWAGE ���� <br /> Distance to Public Sewers _ &L Connection necessary: Yes Not <br /> Does existing septic system comply with Ord. #549 : Yes No <br /> Unknown If/no, explain: <br /> n _ <br /> Describe s ti in al,l t t'o be tnst e -fog ✓ �� <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No__4 Is well proper: <br /> Yes` No StAte deficiency : — <br /> Does existing or purposed use make this well public water: Yes <br /> NoSample of well water taken: Yes No Date t <br /> Resu is Additional information or comments <br /> 3 . GARBAGE & REFUSE 6,� <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . E.LLy-, MOSQUITO OR Y 'ry ) MTJaNTILL / <br /> State possible vector potential & necessary control . <br /> 5 . TQ LI ET/BATH FAC IIJI <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTf!Fa <br /> ��Ti�/�r <br /> 7 . GENERAL SANI'PA=1IQU ✓/ <br /> State any problems not previously .noted: 'f�C- <br /> 8 . POPULATIQN DENSIT-1 <br /> Appx. No. People per sq. If,i. /P� �dG%�/ '� c�✓/,�� �� <br />