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s . SFEWAGE <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 /> 2 . WATER SUPPLY <br /> Is wa r supplied by private well: Yes L/ No Is well proper: <br /> Yes. No State deficiency: <br /> Doisting or porposed use make this well public water: Yes <br /> Noes�Sample of well water taken: Yes No.A0,_- Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE tic REFUSE <br /> Licensed scavenger pick-up: Ye!_,__,ffo Service Area No. <br /> Other proposed disposal method-- <br /> Potential problem: <br /> 4. FLY, M05OUTTQ OR VEQTOR PC)'LZNTTAL - <br /> State possible vector potentcontrol: <br /> 5 . TOILE /BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS 9P +.RATTON HISTORY rr 1 <br /> 7 . GENERAL SANTIA rTON <br /> State any problems not previouvly_noted: <br /> a . POPULATION DENSTTY <br /> Appx . No. People per eq. mi. <br />