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1 . 2EWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 0549 : Yeses No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY <br /> Is water supplied by private we" I : Yes �flo Is well proper: <br /> Yes NoState deficiency: v �-,a) ',4 <br /> Does fisting or porposed use make this well public Water: Yes <br /> No Sample of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,-. MOSQUITQ QRyZ2QT EL)rM AL <br /> State possible vector potentiftl Fz necessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No. & location existing : _ Additional <br /> facilities needed _ <br /> 6 . pgEVIOPS OPERATIOi1 HISTORY <br /> 7 . GENERAL SAJITTATION <br /> State any problem: not previously noted: <br /> 8 . pOI'ULATION DENSITY <br /> Appx, No . People per sq. mi . <br />