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1 . SEWAGR fi <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 wzPr supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Doe.lk 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& REFOSE <br /> Licensed scavenger pick-up: Yes �__ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: U�`P <br /> 4 . FLY. MOSOUITO OR V 1:QTQR P0'r21NTTAL <br /> State possible vector potentiftl necessary control: <br /> k <br /> 5 . TOTL .T/BATH FACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PRRVTOnS OPER4TTON HISTORY <br /> 7 . GENERAL SANTIATTON <br /> State any problems not previously noted: N�y� <br /> 8 . POPULATION DF�YST <br /> Appx. No. People per sq. mi . <br />