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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes 4ii6_ <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 I well proper: <br /> Yes -o— State--def iciency: ► <br /> Does existing or porposed use make this well public water: Yes <br /> No ✓Sample of well water taken: Yes No Date taken <br /> Results Additional information or ,cqMments <br /> 8 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOTT,ET/BATH FACTLITES -__--� <br /> No. & location existing: Additional <br /> facilities needed <br /> 8 . PRFVTOnS opERATIoN HTSTnRY�+ <br /> 7 . GENERAL SAITTTAI ON <br /> State any problems notpreviously noted: <br /> 8 . POPULATION DENSTTY - <br /> Appx. No . People per eq. mi . <br />