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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 . <br /> nstalled:2 . WATER SUPPLY <br /> Is water supplied by private well : Yes �No— Is well proper: <br /> Yes No!/_ State deficiency: EQ <br /> -X, <br /> Does ex�� ng 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 /> Vac <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY� MOSOUTTO ORY {i- ) EC)LENTIAL <br /> State possible vector potentiftl & necessary contro-1: <br /> 5 . T LI ET/BATH FAC =M <br /> No. & location existing - Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H_La RY <br /> 7 . GENERAL SANITA'Ul)_ . <br /> State any problems not Previously noted <br /> 8 . �OP[TLATI����jF�"ciSITY <br /> Appx. No . People per sq . mi . - <br /> _ <br />