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1 . 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 . WATER SUPPLY <br /> Is water supplied by private well: , Yes No Is. well proper: <br /> Yes- <br /> No— State <br /> �lGowr��.{OU D-LF��r . /f%9/1'c� (�/lf/s✓G�,Jc�9•C� e�.GF/✓7/��i'��7�'�Igl� ��o.,/r.�E� <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 /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes zlr No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. =L MQSQUITO OR Y 'a ) F_C)FEN IAL <br /> State possible vector potential & necessary control :^�,4�' 6 <br /> 5 . TQILET/BATH FACILITM <br /> No. & location existing:__ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANI'LaIJI N <br /> Sta.te any problems not previously noted, <br /> 8 . POPULATIQN DENSIT-1 <br /> Appx. No. People per sq. rr,i.��/�'���.CE-�''r�f/�<` i'�•� <br />