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1 . SEWAGE <br /> Distance to Public Sewers "" Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yeses_ No— <br /> Unknown If no, explain : <br /> Describe septic in tallation 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 <Z_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 isposal method: <br /> Potential proble <br /> 4 . FLY L_MOS )UITO OR Y ",TOR PO'T�1�LTIbL <br /> State possible vector potentw necessary con�rol. <br /> 5 . TOILETIBATH FACILIT <br /> No . & location exiting: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not eviously noted: _ <br /> A <br /> 3 . PQPULATIQN DENSITY <br /> Appx. No . People per sq. mi._ <br />