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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes N91�_' <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installat on to be installed:.O�/wi,e <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No x. Is well proper: . <br /> Yes No State deficiency : l F� f���l�F�• �� �' � 'F A1';- �',y� <br /> Does existing or porposed use make thin 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 method: <br /> Potential problem: - <br /> 4 . <br /> roblem: _4 . FLY-.,- MOSQUITO OR_Y ?f_P_C)T=1AL <br /> State possible vector potential & necessary control : <br /> 5 . TQLETS ATH FACILUES <br /> No . & location existing: /,!�` Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIST RY <br /> 7 . GENERAL SA11I'TA`P0a <br /> State any problems not Previously rioted: <br /> B . POPULATIc�� <br /> Appx. No . People per sq. mi . �i/.tie7c � �y4df-�����.•����..ro�� . <br />