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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nom <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 State No o deficiency:�� <br /> ,a , <br /> Does xisting or porposed use make this well p 7c water': Yes <br /> No- Sample of well water taken: Yes No Date taken <br /> Renu is Additional ir�format.ion or corrime its _ 4 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No )�L Service Area No . <br /> Other proposed dispos- 1 method., <br /> Potential problem: a�f <br /> 4 . FLY . MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: ,01'o'-f <br /> 5 . ()TLET/BATH FAC <br /> No . &. location existing : 41 � Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATIQN <br /> State any problems not previously noted : ' <br /> 8 . POPULATION DENSITY <br /> Appx . No . People per sq . <br />