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///).dGP I /�Gj/ter <br /> V1 . <br /> 1 . SEWAGE F <br /> Distance to Public Sewers Connection 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 . 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 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 . Eli-, MOSQUITO ORY ? EC)'LE NTIAL <br /> State possible vector potentiftl & necessary control : <br /> No . & location existing: _...— Additional <br /> facilities needed _ __- <br /> 6 . PREVIOUS OPERATION HJa= <br /> 7 . GENERAL SANITA`. LM <br /> State any problems not pre.viout=fly noted: — — <br /> Appx. No . People per sq . ml . - <br /> _ <br />