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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yea No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> Z . <br /> Is war supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public crater: 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 O$ V CTO) EC)r fNTIAL <br /> State possible vector potentiftl necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION S 'ORY <br /> 7 . GENERAL SA2jITA'1'ION <br /> State any problems not previously noted : <br /> 8 . POPULATION DENSITY <br /> Apex . No . Peorile rner ra . mi . <br />