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1 . SEWAGE <br /> Distance to Public Sewers _-G� Connection necessary : Yes Ng, " <br /> Does existing septic system, omply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Des ri,t)e sept ' it tallation to be installed: <br /> �E.0 _ <br /> 2 . WATER SUPPLY <br /> Is water supplied by. private well : Yes -,e— No Is well proper: <br /> Yes No--- State deficiency - <br /> -- <br /> Does existing or purposed use make this well public water : Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Resu s Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes 4 No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem,: _ <br /> 4 . =,— MOSaUITQ OR—YECTOR POE NTIE L <br /> State possible vector poten.tinl necessary control : ���� <br /> 5 . TOILETIBATH FACIAL <br /> No . & location existing: '% `___ Additional <br /> facilities needed__ <br /> 6 . PREVIOUS OPERATION HISTfi <br /> 7 . GENERAL SANI'1'A'1'I_Q_U <br /> State any proble►nc not previously noted: <br /> 3 . POPULATION DFN3111 <br /> Appx. No . People per sq. <br />