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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 pr. ' - well : Yes No Is well proper: <br /> Yeses No State deficiency : <br /> Does existing or purposed 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 /> ------------------ �� �, �--;�. •> '� h� ..fir �� c <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: _ <br /> 4 . Eli1, MQSOUITO OL_Y Z;, ) ECIrE. LIAL <br /> State poSsible vector potentictl & necessary control : <br /> 5 . ET/BATH FACIA S <br /> No. & location existing - __. Additional <br /> facilities needed <br /> 6 . RVTQQ,5 OPERATION HTS <br /> r � a <br /> 7 . GENERAL SANIT =_M <br /> State any prol)lems not previo-Usly noted : _ <br /> 8 . POPUL TIC)TLL}Ei4LI'Y <br /> Appx , No . People per sq. mi . _ _ <br />