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1• SEWAGE <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 /> . <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yep No Is 1�proper: <br /> Yes No State deficiency:, �f�� �'�'/'� �E ��s <br /> Does existing or porposed use make this we'll 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 . FIX.- MQSQUITO OR VAR--Mrl'N <br /> State possible vector potentiftl ?.c necessary control : <br /> 5 . TQTLET/BATH FACILITES <br /> No. & location existing. ��_ Additional <br /> facilities needed <br /> 6. PREVTO(1,S OPERATION HISTORY <br /> 7 . QEN +,RAL SANITATION <br /> 'ION <br /> State any problem: not Previously noted: <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />