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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown Ii 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 ��REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:_,..._ <br /> 4 . FLY, M SQUTTQ.-QR–YEQTQR PO'CEi NTIAL <br /> State possibly: vector potentiitl & necessary control: <br /> 5 . TQTLET/BATH L ACTLITF.,1 <br /> No. & location existing: Additional <br /> facilities needed- <br /> 6. PRRVTOnS QPRRATIL HISS <br /> 7 . GENERAL SANTTATTON <br /> State any problems not previously noted: <br /> 8 . POPULATTQ14 tfF's, aTTY <br /> Appx . No. People per req. mi. <br />