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I . SEWAGE <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 . MATER SUPPLY <br /> Is r supplied by private well : Yes �. No_ Is well proper: <br /> Yes No State deficiency : — <br /> aL <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 . <br /> roblem: _4 . FLY� MOSOU ITQ OR Y 'C ) EC)FE ITTIALL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILUES <br /> No. & location existing *_ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION__iIaTq <br /> 7 . GENERAL SANI'n <br /> State any problems not previously noted.- - <br /> 8 . <br /> oted: —S . PQPULATION DEIJ=v <br /> Appx. No . People per sq. mi .- <br />