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_ e <br /> J <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 /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes`-• No State deficiency: <br /> Doea,existing or porposed use make this well PL <br /> Plic water: Yes <br /> Nom Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed avenger pick-up: Yes No Service Area No . <br /> Other propos disposal method: <br /> Potential problem; <br /> 4 . Fla., MOSQUITO OR V E^. x PSSTI. I'LL <br /> State possible vector 1'x�tential & necessary control : <br /> 5 . TQI_LETf ATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H " . RY <br /> 7 . GENERAL SANITATJQM <br /> State any problem, not previously noted: - <br /> 8 . <br /> oted: _3 . PQP ILL ATI OTS DENSITY <br /> Appx. No. People per sq. mi. _ <br />