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Y <br /> 1 . SEWAGE <br /> Distance to Public SewersConnection necessary: Yes Na! <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 water supplied by private well : Yes flo Is well proper: <br /> Yes No State deficiency : <br /> Dorps existing or porposed use make- this well public Water: Yes <br /> NoSample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE .REFUSE <br /> Licensed scavenger pick-up: Yeses No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: Ay�� <br /> 4. FU,,_ MOSQUITQ OR V E^.TO) EC)rXNj_TAL <br /> State possible vector potentiFtl Fz necessary control : <br /> 5 . TO .T/BATH FACILITES <br /> No . & location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVT002 OPERATION H � <br /> 7 . GENERAL SANIT '1,A 'ION <br /> State any problems not previously noted: <br /> 8 . EOPULATION D NST11 /lam 1 <br /> Appx. No . People per eq . mi . � �. <br />