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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord , tt549 : Yes— No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> wry' I <br /> 2. tl � il� <br /> Is water supplied by pri ate well : Yes '_ No_ Is well proper: <br /> Yes—b,l�o_ 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 & REFUSF, <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal metr — <br /> Potential problem: <br /> 4 . =. MOSQUITO OR V QTO aC)fLB ATT <br /> State possible vector potential & necessary control : <br /> 5 . TOILFT/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRRVIOt1S OPERATION HISTORY <br /> 7 . GENERAL SANITA'T'ION <br /> State any problems not previously noted: <br /> 3 . POPULATION DEHISITY <br /> -- <br /> Appx . No . People per sq . mi. <br />