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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : 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 _ ido_ 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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up : Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLYS MnsouiTO OR Vz^TO aC)r aTT_AL <br /> State possible vector potential & necessary control : <br /> 5 . Z,TLET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed--- <br /> 6 . <br /> eeded _6 . PRF.VTGUS 0PER.ATIO1L=,T ,,Y <br /> 7 . GENERAL SA2UTATION <br /> State any problems not previously noted :— <br /> 8 . <br /> Appx. No . People per sq. mi . <br />