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1 . SKWAGE <br /> Distance to Public Sewers Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . 0549 : 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 Is well proper: <br /> Yes No State de:P:.ciency: <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 . MOSQUITO OR VMQTC)R F0'j',NTIAT, <br /> State possible vector potential 8A necessary control: <br /> 5 . TOTLETtBATH FACITIITES <br /> No . & location existing: Additional <br /> facilities needed - - <br /> 6. PREVTOUS OPERATION HT DORY <br /> 7 . GENERAL SAt TIATION <br /> State any problems not Previously noted: <br /> 3 . POPULATION DF�YSTlY <br /> Appy - No. People per al . mi . <br />