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i . SEWARK <br /> Distance to Public Sewers � Connection necessary: Yes L No_ <br /> Does existing septic system comply With Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Deseripe se t i�lstahl tion to 'be installed: ����'E<r % ��� �c<<✓�t <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes NoIs well proper: <br /> Yes No State deficiency: % - <br /> Does existing or porposed use make this well public water: Yes <br /> Nom„ Sample of well water taken: Yes NoDate taken <br /> Results _ Additional information or comments <br /> 3 . GARBAGE & RRFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FLY. MOSQUTTO OR VC,-,TOR PQT2,NTTAL <br /> State possible vector potentiftl 8.c necessary control: .�'f�'�` <br /> 5 . TOTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . P„EVTOnS OPERATION HISTORY <br /> 7 . GENERAL SANIIATTON <br /> State any problems not previously noted: ���` <br /> 8 . POPULATION DEN TT_Y <br /> Appx. No . People per sq. mi.,�6��'�/��.Pf —���.c'/�ti9��f✓����fG <br />