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1r <br /> 1 • �.i <br /> SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes NoL_ <br /> Unknown If no, explain: <br /> Describe septic installation to *be nstglled: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: <br /> Yeses. No State deficiency: <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: G tlV' <br /> 4. FLY. MOSQUITO OR VECTOR P0'P ,NTIAL <br /> State possible vector potentiftl R.: necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTOUS OPEEATIoNHISTORY <br /> 44 <br /> 7 . GENERAL SANTA' TON <br /> State any problems not previously noted: <br /> 3 . POPULATION PENSTTY j. <br /> Appy. No . People per sq. mi. <br />