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i. SEWAGE <br /> Distance to Public Sewers � Z Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes,,- No_ <br /> Unknown If no, explain: <br /> Descr be se p c nstall�tlon to 'be installed: <br /> 2. MATER SUPPLY <br /> Is water supplied by private well : Yes X No Ir, 11 proper: / <br /> Yes No State def.ci,.ncy: <br /> Does existing or porposed use make this well public water: Yes <br /> No 1 Sample of well water taken: Yes Nom 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 method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR VECTOR PQ'[21NTTAL <br /> State possible vector potentiftl Pg necessary control: <br /> 5 . TOTLET/BATH FACILIT'-Fd <br /> No . & location existing: - Additional <br /> facilities needed <br /> S . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANT_TATTON <br /> State any problems not ,previously noted: <br /> 3 . POPULATT_014 DENaTTY \ <br /> Appx. No . People per sq. <br />