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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes Nom <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 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 /> Result Additional information or comments_��r,T�� /t• <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. L MOSQUITQ OR V QT,E__EC)L3 NTIAL <br /> State possible vector potential & necessary control : <br /> 5 . T ILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H13TORY <br /> 7 . GENERAL SANITATION _ <br /> State any problems no :, previou.sly noted - ___ <br /> S . POPULATION DENSITY <br /> Appx. No. People per (3q . mi . _� <br />