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1 . SEWAGE <br /> Distance to Public Sewers A Connection necessary : Yes No✓/ <br /> Does existing septic system comply with Ord. #549 : Yes No:L <br /> Unknown If no, explain: <br /> N10 <br /> Describe septic i stallation o e ngtalled: <br /> � - <br /> 2. . WATER SUPPLY <br /> Is water supplied by private well : Yes No L"�Is well proper: <br /> Yes No State deficiency: <br /> /)6 fitly-ll 0)', J'f �i <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . ARBAGE & REFUSE <br /> L%,,ensed scavenger pick-up: Yes No Service Area No. <br /> Oroposed disposal method: <br /> Pal problem: <br /> 4 . FLY POTENTIAL <br /> State possi 711e vector potential & necessary c ftrol : <br /> 5 . TOILET/BATH FACILITES- <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY.- <br /> 7 . GENERAL SANIT TON <br /> State any problems not previously noted: <br /> 8 . PQPtlLATION DENSITY <br /> Appx. No . People per sq. mi . <br />