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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 /> , <br /> 2 . WATER SUPPLY <br /> Is water supplied by private weil : Yes No Is well proper: <br /> Yes - No State deficiency: <br /> Does existing or porposed use make this we'll 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 . FILL, MOSQUITO OF U^ UaPS�'LE TIAL <br /> State possible vector potenti&l. & necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION. <br /> State any problems not previously noted : ._ <br /> 8 . POPULATION DENSITY <br /> Appx. No . People per sq . mi . -- <br />