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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 /> -7� <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied. by private well: Yes�ija Is well proper: <br /> Yes. 10 State deficiency: <br /> Does ex ting or porposed use make this well public Water: Yee <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 method: <br /> Potential problem: <br /> 4 . MOSQUITQ OR VMUM P.�:!'r ZIA114 <br /> S ate possible vector po entietl 8,c necessary control: <br /> r-cz 0 <br /> 5 . TOILET/BATH FACILITES <br /> No. ec location existing: Additional <br /> facilities needed _ <br /> 6 . PREVTOTTS nPERATION HTSTORX <br /> e <br /> 6X ^14 <br /> 7 . GENERAL SA11ITATION <br /> State any problem; not previously noted: <br /> 8 . EOPULATI014 DENSTIv <br /> Appx. No . People per sq. mi. <br /> 'qofox ), e- <br />