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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No,_,.,, <br /> Does existing septic system comply with Ord. #548 : Yes No— <br /> `Unknown If no, explain: <br /> Describe .septic installation 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 Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & AEROBE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSOUTTO OR Vr,,C.T_ORi' <br /> State possible vector potential necessary control: <br /> 5 . TOILET/BATH FACI.LTT <br /> No. & location existing: Additional <br /> facilities needed <br /> S. )rIs OPRIRAITQU HTSTORY. <br /> 7 . GENERAL SAKI' AT?GN <br /> State any problems not previously noted: <br /> $ . POEU ATIQN DRHSITY <br /> Appx. -No. People per sq. m i. <br />