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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 /> /✓ry r S a�dti� <br /> Describe septic installation to 'be installed:- <br /> 2 . <br /> nstalled: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: Yee <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 . ELY MOSQUITO OR —VECTOR PCLEIjT AL <br /> State possible vector potential & necessary control : <br /> N <br /> 5 . ZQILF.T/BATH FACILiTTES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PRFVr US OPERATION HISTORY <br /> 7 . GENERAL SAPITTATION <br /> State any problems not previously noted : _ <br /> t-1 <br /> 9 . POPULATION DrFNSTTy <br /> Appx. No . People per sq. mi . <br />