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SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 0549 : 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 L' No Is well proper: <br /> Yeso State deficiency : <br /> Does 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 & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,,_ MOSouiTO OR VE^TO PTr�TI <br /> State possible vector potentiftl necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREy_IOPE OPERATION HIS =( <br /> 7 . QENERAL 2ANITA`1'ION <br /> State any problems not previously noted: - <br /> 8 . <br /> oted: _8 . j'OPULATION Dr i1,,TTY _ <br /> Appx. No . People per sq . mi . �� <br />