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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 If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well , Yes Na Is well proper: <br /> Yes No State deficiency — <br /> Does existing or porposed use make this well public water: Yes <br /> Na 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 Na Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:__ <br /> 4 . FLYS MOSQUITGOT Y o P MENTIAL <br /> State possible vecto,- pc,tentin.l & necessary control : <br /> 5 . TQILET/BATH FACI Ma <br /> No. & location existing: Additional <br /> facilities needed-- <br /> 6 . <br /> eeded -6 . PREVIOU,a OPERATION .IaM <br /> 7 . GENERAL SANIjA'i_'T0ff <br /> State any problems not previously noted- <br /> 8 . <br /> oted:S . POPULATIQN DENSITY <br /> Appx. No . People per eq . mi . _ <br />