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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 /> 2. WATER SUPPL7 <br /> Is water supplied. by private well : Yes No 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: Ye's No Date taken <br /> Results Additional information or comments <br /> 3 . OAPPAGE & REFUSE <br /> Licensed scavenger pick-up: Yes 'No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FT,Y,_ MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILF�T,LBATH EAQ ITE <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION, <br /> State any problems not previously noted: <br /> a . 20PITLATION DENSTTY <br /> Appx. No. People per an. mi. <br />