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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 /> nC.y Scc <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-T—i Sample of well water taken: Yes No >1 Date taken <br /> Results Additional information or comment's <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 L MOSQUITO OR Yr�'TORPG f ENT IAL <br /> State possible vector potential & necessary---control: <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: __. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIS ,ORI <br /> 7 . GENERAL SANITATION. <br /> State any problems not previously note <br /> 8 . POPULATIQN Y <br /> Appx . No . People per sq . mi .- <br />