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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 <br /> Unknown If no, explain : No_ <br /> Describe septic installation to be installed: <br /> 2 . MATER SC7PPr,7 <br /> Is water supplied by private well : Yes NO Is well proper: <br /> Yes NoState 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 /> 3 . GARBAGE & RS USF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAY, MOSQUITO OR VE"TOR PQTZNTTAT, <br /> State possible vector potential & necessary control: <br /> 5 . TOTL .T/BATH FAC ILTTF, <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVI0nS r; rRATT0f4 RTSTnRX <br /> 7 • GRNFRAL SA?ITTATTON <br /> State any problems not previously noted : <br /> 9 • POP-TILATTOMRUSTTX <br /> Appx . No . People per eq . mi . <br />