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1 . SEWAGE r' <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 /> Z . WATER SUPPLY <br /> Is ; No— <br /> er supplied by private well : Yes No Is well proper: <br /> Yes State deficiency: <br /> Doe xisting or porposed use make this well p lic water: Yes <br /> NoM Sample of well water taken: Yes No. Date taken_, <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFIISR <br /> Licensed scavenger pick-up: Yes2 No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO R VECTnR POTI':NTTAL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. ec location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION O <br /> 7 . GENERAT. ANTTATTON <br /> State any problems not Previously noted : ._ <br /> 3 . POPULA1I014 DRUSTTX � <br /> APpx. No . People per sq . <br />