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I . SEWAGE --------- <br /> Distance <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 /> Describe septic installation to be installed: <br /> 2 . MATER 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 /> Results 4 Addi ional information or comment ✓✓ia� <br /> Are <br /> � \ <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 YEL L) EL)FENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACI TI a _ <br /> No. & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANT.. TI—Q)N <br /> State any problems not previously noted: _ _ <br /> S . POPULATION DENSITY <br /> Appx . No. People per eq . mi . _ <br />