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1 . SEWAGE <br /> Distance to Public Sewers yam" Connection necessary: Yes NoX <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installa ion to be installed: <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is viell proffer: <br /> Yes--Z_ No/ State deficiency : 4�zk ,X, <br /> Does existing or porposed use make this well public dater: Yes <br /> No Sample of well water tarsen: Yes No Date t ien <br /> Resul s 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-,,- MOSQQITO OR V ^.TQ ZC)METIA . <br /> State- possible vector potentiftl & necessary control : �� <br /> 5 . Tei .T/ ATH EACILLITES <br /> No . & location existing : '� _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS nPERATION H 0£Y <br /> 7 . GENERAL SAPL11 '1.A ' —C) <br /> State any problems fiat prevlously noted: <br /> 3 . gn 1LATION DEN STIv - <br /> Appx . No . People per 6q . mi . <br />