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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes N4 <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unk wn If no, explain: <br /> Deq_ r be i-c installation to be installed: <br /> e, <br /> 2 . MATER SUPPLY <br /> Is water supplied by private iaell: I'es �No Is well proper: <br /> Yes No State deficiency : <br /> Does sting or porposed use make this well pu` c water: Yes <br /> No Sample of well water taken: Yes No 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. EL1. MOSQUITO OR U2,M) ELME TIAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing : __ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITALTIM <br /> State any problems not previously noted- - <br /> 8 . <br /> oted: _S . POPULATION DIH5,111 -- <br /> Appx. No. People per sq. mi ._ <br />