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1. SEWAGE <br /> Distance to Public Sewers .11:;�L_ Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord. #549 : Yes1 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 .2�, No Is well proper: <br /> Yeses 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 /yo ' <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: y,tle <br /> 4. FLY. MOSQUITO OR VrQTQR_PO'r ,NTIAL <br /> State possible vector potentifel & necessary control: <br /> 5 . TOTT,F�T/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRRVTORS OPERATION HISTORY <br /> 7. GENERAL. SAITTIATTON <br /> State any problems not previously noted: <br /> 3 . POPULATION DEYSTTY <br /> Appx. No. People per eq. mi.��i��/���.PE�.����►.� <br />