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1 . 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 is� tallation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes L"--No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes Fqy_ 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. FLYL MOSQUITO OR VE^TQC ZCi'j' ,NTIAL <br /> State possible vector potentiFtl Fz necessary control : <br /> LcJ�S - , <br /> 5 . TOILET/BATH FACILITES 5 � <br /> No . ec location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HIST ( <br /> f <br /> 7 . QENERAL SA1UjAT'l?N <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DE 43111, <br /> Appx. No . People per <br />