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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes Y 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 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Doesxisting or porposed use make this well public water: Yes <br /> - <br /> No <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: Yeses No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . L rioSwUJTQ OR V i^TC) PC)'r nLT_AL <br /> State- possible vector potentifil ?.c necessary control : <br /> 5,. T0ILFT/BATH FACILITES <br /> No . & location existing: _. �I,%' Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTO ( ` ` .0 <br /> 7 . GENERAL SAPiL:r.A:CI()N <br /> State any problems riot previously noted : _ <br /> 3 . PC)PULATION DENSITY <br /> Appx. No . People per sq. mi . <br />