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1 SEWAGE <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 water 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: 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. FLY, MOSDUITQ OR Y Z^, F-CMMIAL. <br /> State possible vector potentiFtl & necessary control : <br /> 5 . TgjLET/BATH EACULLILEa <br /> No . & .location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTfi <br /> 7 . GENERAL SAN,LTAl -Itl <br /> State any problems not previouU).J note(-♦. : ____—`_ <br /> 3 . POPULATION LtiFirUll <br /> Appx. No . People per sq . mi ._ _ <br />