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odd o <br /> 1. SEWAGE - s <br /> Distance to Public Sewers I ` U Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No <br /> Describe septic installation to be installed. C Z4 <br /> 2. WATER SUPPLY /--Op-g <br /> I <br /> Is water supplied by private well: Yes AOOtNo Is well proper: Yes ✓'" No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes No Sample of well <br /> water taken: Yes No !/Date taken Results <br /> ditional information or comments: — "� ��vy► <br /> 3 ARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problems: <br /> 4. FLY, MOSQUITO. OR VECTOR POTENTIAL j <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH FACILITIES / <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVAOUS OPERATION HISTORY <br /> jK ^ .<- <br /> It <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> Appx. number of peDp1& quare mile <br />