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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 /> 2 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is dell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> No Sample of well water tarsen: 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 meth d: <br /> Potential problem: / <br /> 4 . F.Ly. - MOSQUITO QR VE2QT0 Z2MBTIAL <br /> State possible vector potentiFtl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: � Additi nal <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> ev-4 tfy –I r7 <br /> 7 . GENERAL SAI I'P `i,}�_'I-ON <br /> State any problems not previously noted:- <br /> 8 . <br /> oted:_8 . Enp 1LIATION DFijSIly <br /> Appx. No . People per 6q . m i . <br />