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r � <br /> 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 /> C 1 <br /> .J <br /> 2 . WATER SUPPIjj <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yea-- 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 /> l (I <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAL MOSQUITO OR I=QQ ' �'I'IINTIAL <br /> State possible vector potential & necessary control: <br /> 6 . TQILET(BATH FACILUES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITA= <br /> State any problems not previously noted.- - <br /> 8 . <br /> oted:8 . POPULATIONNNITY <br /> Appx. No . People per sq. mi._ <br />