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1 . SEWAGE <br /> Distance to Public Sewers �$OFrConnection necessary: Yes_ No <br /> Does existing septic system comply with Ord . 0549 : Yes_ No <br /> Unknown If no, explain : <br /> ,1-1)0 �Ofics w s �.61rc �s . <br /> Describe septic installation to be installed: <br /> Nom. <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes iso_ 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 & REFUSE ✓ Ca� LI�aS{e <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY , MOSQUITO OR VZCTORPOTENTTA , <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/HATH FACTL,TTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS C:PERATION HTSTnRY <br /> 7 . GENERAL SANTTATTON <br /> State any problems not previously noted: <br /> S . POPUr,ATTON DENSTTY <br /> Appx. No . People per eq . mi . <br />