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b <br /> l . SEWAGE wo- <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 SUPPL`� <br /> Is water supplied by private well : Yes too 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: Yes No Date taken <br /> Results Additional information or comments-'+ <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELI, NQSQUITQ QF, Y1 TOR fl'MIAL <br /> State passible vector potential & necessary control : <br /> 5 . .ya <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS . a,R&TT4� TQRY <br /> f-. GENERAL SANITA= - <br /> State any problems not previously noted: <br /> 8 . PUMATIOOLE 'Y <br /> Appx. No . People per sq. mi . - <br />