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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #54 , Yes, No— <br /> Unknown�. If no, explain: <br /> Describe septic installation to 'be nstalled: <br /> 2. WATER SUPPLI <br /> Is Water supplied, by private well: Yes j6L-'P'140L�Ie well proper: <br /> Yes No State deficiency: <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. E,^TOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TGiLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREYTOUS r_EREATTQH .gISTMY <br /> 7. GENERAL SAITITATION <br /> State any problems not Previously noted: <br /> 3 . POPULATIQ2 DENZITY <br /> Appy. No. People per eq. mi. <br />