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. 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 /> JD Uc., <br /> 47 J <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 tarsen: 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 . ELi1,- MOSQUITQ OR V fQTQ E2M <br /> State possible vector potentiftl & necessary control : <br /> 6 <br /> 5 . TOILET/BATH I'ACILI 'F'S <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPER.ATIQN H=, <br /> �, <br /> 7 . QFNERAL SANITATION <br /> State any problem.- not previously noted : _ <br /> S . EO > ILATION DENSTTY <br /> Appx. No . People per rq . mi . <br />