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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 /> Z . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No 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 /> GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> otential problem: <br /> 4. r 0 R yU,;� F 0 ILUNTIAL �✓`' <br /> State ossible vector potential. & necessary c:ont�r�7 : <br /> 5 . TQILET/BATH F ILII <br /> No. & location misting : Additional <br /> facilities needed' ,-__ <br /> 6 . PREVIOUS OPERATION HI` 'ORY <br /> 4 <br /> r <br /> 7 . GENERAL SANITA`T'ION ` <br /> State any problet ` n t previously n ted: <br /> S . OPUTATM 14 pElTY <br /> Ap No. People per sq. mi . <br />