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1 . SEWAGE <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. MATER SUPPLY <br /> Is water supplied by private well : Yes No Is dell 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 . <br /> roblem:4 . =,- MOSQUITO OR VE^.TO Z2r T AL <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FCILITFS <br /> No. & location, existing: _ Additional <br /> facilities needed _ <br /> 6 . PRFVTOT]s C)PERATIOid HI sTOF:Y <br /> 7 . GENERAL SAPTI1A'1'ION <br /> State any problems not previously noted : <br /> 8 . POPULATI014 DEtISTTY <br /> Apex. No . People per sq . mi . <br />