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1 . SEWAGE <br /> Distance to Public Sewers _ � Connection necessary: Yes No <br /> Does existkfig septic system comply with Ord. #549 : Yens Nor._.- <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> /a= gaJ k <br /> 2 . WATER- SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: <br /> Yes No State deficiency ! <br /> Does ,sting or porposed use make th.is well p)ic water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> -e kt yr u»l! <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service: Area No. <br /> Other proused disposal method: <br /> Potential roblem! <br /> 4. FLY VECTOR POTENTIAL <br /> State possible vector potential & necessary co • trol : <br /> I <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing. z Additional <br /> facilities needed (ypY <br /> 6. <br /> Z\ <br /> 7 . GENERAL SANITA`�.'TON * <br /> State any problems not p evious ly noted: <br /> 8 . PQPULAATION DEtjajT-j <br /> APpx, No. People er sq. mi. . - � _ <br />