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SEWAGE <br /> _--- <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 <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes State deficiency : <br /> f <br /> Does existinVor porpos'ed use make this wel ublif wate;:` 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 . FLY MOSQUITO OR VEM EC)MMAL. <br /> State possible vector potentiFtl & necessary control : <br /> 5 . TOTLE.T/BATH FACI TTES <br /> No . & location existing : Additional <br /> facilities rieF ded _ <br /> 6 . PTVTnLIq C; i ATIOt4 HISTORY <br /> - Y <br /> 7 . GENERAL SAPITTaTION <br /> State any problems not previou 1. <br /> 8 . POPULATION DE S11Y <br /> Appx. No . People per req . mi . <br />