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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes NoZ— <br /> Does existing septic system comply with Ord . #549 : Yes ✓No_ <br /> Unknown If no, explain: <br /> q3 ) <br /> .v ✓ti � ,tis <br /> Describe septic installation to be installed: <br /> cl h <br /> Q•yl CI t—c 7 <br /> 2 . WATER SUPPLY <br /> Is water SLtpplied by private ;cell : Yes '✓ Pio Is well proper: <br /> Yes--L No State deficiency : <br /> Doeo,,existing or porposed use make this well public water: Yes <br /> No Sample of well water tarsen: Yes No ✓Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenge pick-up: Yes No Ser ce Area No. <br /> Other proposed disposal method: <br /> Potential problem: � <br /> 4 . MOSQUITO <br /> State- possible vector potentiitl 8& nee ssary control: <br /> 5 . TQ T/ ATH FACILITES <br /> Na . & location existing: Additional <br /> facilities needed _ <br /> 6 . PRE,VTOOS nPERATION H ; <br /> 7 . GENERAL SAIJIT '1,A 'IOC] <br /> State any problems 2iot previously noted: <br /> 8 . M ILATION DEI,,ITY <br /> Appx. No . People per sq. mi . <br />