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i <br /> � . SEWAGE -7 <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 /> ' <br /> Describe septic installation to be installed : l% <br /> h'! sa <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ,- No Is well proper: <br /> Yes —No-/- State deficiency : / <br /> Does existing or porposed use make this well <br /> publicwater: Yes <br /> No y Sample of well water taken: Yes No Date taken <br /> Results /JAdditional information or comments <br /> y&' a% o <br /> v <br /> 3 . GARBAGE & REFUSE f <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FLY, MOSQUITO OR VECTOR PO'KNTTA <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACI LTTFE <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DEN <br /> Appx . No . People per sq. mi . <br />