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1 . <br /> 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 : Yesy no Is well proper: <br /> Yes State deficiency : <br /> Doisting or porposed use make this well public water: Yes <br /> Noes�Sample of well water tarsen: Yes No-4ZDate 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 VEQTOR P0fL-HTIAj1.L <br /> State possibly' vector potentiftl FA necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVTOrIS OPER.ATI ILE O£;Y <br /> F <br /> 7 . QFNERAL SAPLjjL1' -(-) <br /> State any problems not prevlously r; _ <br /> 8 . F- ILATION Dr i STTY <br /> Appx. No . People per r_:q . r;,i . <br />