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i . SEWAGE <br /> Distance to Pub ^ <br /> Public sewers � �� /yConnection necessary: Yes 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 . HATER D(TE LY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Ye No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Dample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . (GARBAGE L-REFUSE <br /> Licensed scavenger pick-up: Yes No % Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR V C�PnTFPdTTAi� <br /> State possible vector potential & necessary control : <br /> 5 . 1 U) L .T/RATH FA(' LITER <br /> No . & location existing : - /J Additional <br /> facilities needed <br /> 6 . PREVIOUS QEERRATION HISTORY <br /> 7 • �3EENERA SANITATION <br /> State any problems not previously rioted: �e�✓f <br /> 3 . EQ U .A 1 N DEN,TTY <br /> Appx . No . People per sq . mi . <br />