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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No <br /> Does existing septic system comply with Ord. #549 : YesNo_,_. <br /> Unknown If no, explain: 2; <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ' No ,Zs we pr per: <br /> Yes No State dei'iciency : _ � �� <br /> Does existing or porposed use make this well public water: Yes <br /> Nom_ Sample of well water taken: Yes Nom 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 . F11L MOSQUITO OR V M^TO EC)MNZ ATL <br /> State possible vector potentiftl & necessary control:.!��';� <br /> 5 . TOILET/DATE FACILITES <br /> No. & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SAPU '1,J� ' (_) <br /> State any problems not previously noted : - <br /> 3 . <br /> oted : _3 . EOPIJLATIO14 DENSITY <br /> Appx. No . People per rq . mi . <br />