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1 . SEWAGE L <br /> Distance to Public Sewers Connection necessary : Yes Noj/ <br /> / <br /> Does existing septic system comply with Ord . tt549 : Yes 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 No Is well proper: <br /> Yes L No State deficiency : <br /> M)CLt7i ()C" <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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . MOSQUITO OR V CTO PLi'TT�TI� <br /> State possible vector potential ?z necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . ec location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTO r <br /> 7 . GENERAL SANITA'1'=0 <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DEN , <br /> Appx. No . People per Gq . mi . <br />