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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 /> Yee 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 . <br /> roblem:4 . =L MOSQUITO QR V QTO PC'i'T jT.I&L <br /> State- possible vector potentiitl & necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities reef ded _ <br /> 6 . PREVTOPE QPERATIQjïż½ 'OFY <br /> 7 . GENERAL SANI'TATION <br /> State any problem: not previously noted : - <br /> 8 . <br /> oted : _8 . POPULATION DENSITY <br /> Appx. No . People per 6q . mi . <br />