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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 installation to be installed: <br /> 2 . MATER SUPPLI �./e <br /> Is water 6upplied by private well : Yes ,rte No Is well proper: <br /> Yes. No State deficiency: <br /> Does "ting or porposed use make this well publ c water: Yes <br /> No � Sample 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 problerr,: <br /> 4 . =L MOSQUITQ OR VE^TOS PS)TjaLT_T <br /> State possible vector potentiftl y iVJ-e-&ssFiry control: <br /> 5 . TOI E /. }ATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PRF,VTOQ2 OPERATION HISTORY <br /> Zne4ll <br /> J, <br /> 7 . QENERAL SANITATION <br /> State any problem: not previously noted' f <br /> 8 . POPULATION DnNSTIX <br /> Appx . No . People per rq . mi . <br />