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4 <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Nc <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: dj%� <br /> 2 . WATER SUPPLY <br /> Iswer 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 /> u <br /> Resis 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 . FLY , MQaQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control .- <br /> 5 . <br /> ontrol :5 . ILFT/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 : �171 C <br /> 8 . POPULATION DENSITY ������� <br /> Appx . No . People per sq . mi . <br />