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i . SEWAGE <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 water supplied by private well : Yes _ No-L— Is well proper: <br /> Yes_ No_ State deficiency: <br /> Doe"xisting 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 & RREUSR <br /> Licensed scavenger pick-up: Yes No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY. MOSQUITO OR VRCTOR Psr �.Nr TIAL <br /> State possible vector potentiril Fi necessary control: <br /> 5 . TOILET/BATH FACILTIES <br /> No. ec location existing: Additional <br /> facilities needed <br /> 6 . PRRyTona fI123gATTot; HTSTnRY <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted : <br /> 3 . POPULATION DF.LiSTTY <br /> Appx . No. People per eq . mi . <br />