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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes__ Nom <br /> Does existing septic system comply with Ord . #549 : YesNo_ <br /> Unknown IE no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Isr supplied by private well : Yes _4 No_ Is well proper: <br /> Yes wa eNo_ State deficiency: <br /> Doe xisting or porposed use make this well p lic water: 'les <br /> No!, Sample of well water taken: Yes_ Nol Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_L No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR V OR E9rCNTIAL <br /> State possible vector potential 8.s necessary control: <br /> 5 . TOILET/BATH FACILITES f <br /> No. & location existing,, � JAdditional <br /> facilities needed <br /> 6 . PREVTOOS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: �T <br /> 3 . POPULATION DENSITY / <br /> Appx . No . People per s1. mi . c� <br />