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1 . SAGE <br /> Distance to Public Sewers Z' -%' Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No, <br /> Unknown If no, explain: <br /> Describe septic installation to be installed : <br /> WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: / <br /> ���/�,��✓ a/�' �%'e�G�'r� ,ls��/Erb/�•'✓���rTs ��!/�lf ���c�.f,��l���/9/i�d <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 & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control - <br /> 5 . <br /> ontrol :5 , TOILET/BATH FAC IT- '1T 'ES <br /> No . & location existing : L? Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 , GENERAL SANITATION <br /> State any problems not previously noted : <br /> g . POPULATION DENSITY <br /> Appx. No . People per sq . <br />