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1 . SEWAGF !� <br /> Distance to Public Sewers / - ` Connection necessary: Yes No l:� <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> /We <br /> DescF,tbe septic installation to be Jn8taled: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Na Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Semple of well water tarsen: 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 . FLY. MOSQUITO OR VEQTOR POfIEZIAL <br /> State possible vector potentifil & necessary control : <br /> Xi2 kili4 <br /> 5 . TO , .T/ ATL CACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PR .VTona OP .RATION HISTO ; <br /> 7 . GENERAL SAIJITaTION <br /> State any problems not previously noted :_ <br /> 8 . ROPULATI914 DENST11 <br /> Appx. No . People per sq . mi . <br />