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I . 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 ?I_/ `Q <br /> Is water supplied by private well : Yes _ No 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 /> r �-- <br /> 3 . GARBAGE & REFUSE S� <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: - <br /> 4. FLY, MOSQUITO OR V aTL) PS)M=AL <br /> State possible vector potentihl & necessary control : <br /> 5 . TOILET/BATH FACILITY <br /> No . & location existing : —__ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISM) <br /> G404 <br /> 7 . GENERAL SANITAL1QU <br /> State any problems not previously noted : -- <br /> 8 . <br /> oted : —_S . OPULATIQN DENSITY <br /> Appx . No . People per sq . rr,i . __ <br />