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I . 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 /> Describe septic installation to be installed : <br /> 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: 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 . <br /> roblems: __4 . FLYS MOSQUITO OR VECTOR pCi'MNTIAL <br /> State possible vector potential & necessary control - <br /> 5 . TQILET/BATH FACILI`17,a <br /> No . & location existing : __. Additional <br /> facilities needed _- <br /> 6 . PREVIOUS OPERATION HIBM= <br /> 7 . GENERAL SANITATID- <br /> State any problem; no tl— previously rioted ,. -- <br /> 8 . <br /> oted ,. —S . PQPULATIQN DETJa TY <br /> ADDx . No . People per sq . mi . <br />