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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 _SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : . <br /> Does existing or pornosed use: make this well public water: Yes <br /> No Sample of well water taken: Yes leo Date taken <br /> Results Additional information or comments - " <br /> f 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELI MDSQUIT.Ca. QR I CTOR 20.,rLRTJAL <br /> State Possible vector Potential necessary control : <br /> 5 . TQ11, T/_BATH FACILI'I'V <br /> No. & location existing: ---- .--- -- _.., Additional <br /> facilities needed <br /> 6 . PREVIOUS OP,E� ?R` I OH H I STORY <br /> l. . GENERAL <br /> State any problems not previously noted:- <br /> 3 . EOPULATIt DE Y <br /> Appx. No. People per sq. mi . <br />