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SEWAGE <br /> Distance to Public Sewers A4Connection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes Nom <br /> Unknown If no, explain: <br /> OLTV V0 <br /> Describe septic installation to be installed: <br /> 2 . MATER S[IPPI,`I <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 tarsen: Yes No Date taken <br /> Res Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Nb Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . M0S0UITn OR V E Q T 0 R EL)rjljAj1.L <br /> State- possible vector potentiftl & necessary control: <br /> 5 . Tei ,TLBATH FACJ.T:F'S <br /> No. & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PRFVIOn; OPERATION HISTORY <br /> r <br /> 7 . GENERAL SAPJI;r TI N <br /> State any problems not previously noted :_ <br /> 8 . POPULATION Dr tISTTY <br /> Appx . No . People per rq. mi . <br />