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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 01 <br /> 2 . WATER SUPPLYQOy,r�-SSV--c"', <br /> Is wat supplied by private well: Yes 4ef�— No_ Is well proper: <br /> Yes _ State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes— No_ Late aken <br /> Results �r Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. p ' <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR VM',TOR POTENTTAT, <br /> State possible vector potentiril 8A necessary control: <br /> 5 . TQTLFT[BATH FACILITES <br /> No . Fc location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS <br /> OPERATIO <br /> N <br /> HISTORY / {ten I _ ` <br /> 7 . GEN RAL SANITATION ` T <br /> State any problems not previously noted: <br /> S . POPULATION DENSITY <br /> Appx . No. People per sq . mi. <br />