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1 . SEWAGE <br /> Distance to Public Sewers > Iboo Connection necessary : No-\'- <br /> Does <br /> okDoes 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 wa er supplied by private well : Yes " No Is well proper: <br /> ro er: <br /> Yes Na State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No ✓ Sample of well water taken: Yes No L---Date taken <br /> Results Additional information or comments <br /> 3 . PAGE & REFUSE <br /> Lice ed scavenger pick-up: Yes No Service Area No. <br /> Other p used disposal method: <br /> Potential oblem: <br /> 4 . FLY, MOSQUITO-- VECTOR PO'j'1;NTIAL <br /> State passible ve tar potential & necessary control ! <br /> 5 . TOILET/BATH +ACT ,ITES <br /> No. & location exiuting : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPF+RATT014 H S OFtY <br /> 7 . GENERAL SANTTATION <br /> State any problems not previously noted : _ <br /> 8 . POPULATIQJL_D NSTTY <br /> Appx . No . People per sq . rr,i . __ <br />