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1 . 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 /> Des,cribv septic ins llation to be installed: <br /> �s <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes Z 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 . =,- MQSQUITQQR Y Z i fir=, ' IAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TQILET/BA H FA _ L7' <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H13- <br /> 7 . GENERAL SANI'�AJLM <br /> State any problems not previously noted: low,/ _. <br /> S . P P Tr,AT7nN DE=-1 <br /> Apex. No . People Per sq. rni <br />