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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 /> o /C c�t't�i'dofr pe nq/f d% %/c <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No—X 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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal me �hod: <br /> Potential problem: 6 <br /> 4 . L MOSQUITO OR EQTQR PQ f U- <br /> State possible vector potentiftl 8z necessary control : <br /> �Y <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PRFVTO02 OPERATION HISTORY <br /> 7 . GENERAL SANITA'1 M <br /> State any problems not previously noted :_ <br /> OX- <br /> 3 . POPULATION DENSITY <br /> Appx. No . People per oq . mi . <br />