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1 . SEWAGE I�,V <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 . WATER SUPPLY <br /> Is war supplied by private well : Yes `/ No Is well proper: <br /> Yes No__ State deficiency: -- <br /> Does existing or porposed use make this well public water: Yes <br /> No , Sample of well water taken: es 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, MQS0U1T0 OR Y EL: P)LEMIAL <br /> State possible vector potentifil & necessary control : <br /> 5 . TQ LI ETZBATH FACIL= <br /> No . & location existing : —_. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTc"iRY <br /> 7 . GENERAL SANITA'1_� J.0 <br /> State any problems not previou.sly, noted: --`— <br /> S . FOPULATIQN M=1 <br /> Appx. No . People per sq. mi .- <br />