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SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes No, <br /> Does exigtjng 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 /> Does existing or porposed use make- this well public crater: Yes <br /> No �� Sample of well water taken: Yes No 's Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE-i REFUSE <br /> Liceneed .pcavenger pick-up: Yes No Servdce Area No . <br /> Other propbred disposal method: <br /> Potential pr'ablerr,: <br /> 4 . L MOSQUITO """c E^TO POiTMTlA�, <br /> State possible vector PO <br /> & cessary control : <br /> 5 . TOILET/BATH F,K11ITES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVTO02 QPERATION HISTORY <br /> 7 . QENERAL SANI'r '1.A 'I()N <br /> State any problems not previously noted :—\ <br /> 8 . PQPjJLATION DE ii,�:)TIY <br /> Appx. No . People per sq . mi . <br />