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SEWAGE <br /> Distance to Public Sewers f.ti- Connection necessary: Yeses 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 well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> NoSample of well water tarsen: Yes No Date taken <br /> Resm ults 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 . FljY-L MOSQUITO OR V Q,-T- Z2f11� TIAL <br /> State possible vector potentiFtl & necessary control: <br /> 5 . TQTLETZBATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HI STS r <br /> 7 . GENERAL SANITATION <br /> ON_ <br /> State any problems not previously noted: -� <br /> 8 . j'OPSILATI_0j4 DEt ` I v <br /> Appx. No . People per 6q. mi . <br />