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i . 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 SUEPLY <br /> Is Hater 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 . GA BA� �� REFUSE <br /> Licensed scavenger pick-up: Yea No Service Area No. <br /> Other prOposed disposal method: <br /> Potential problem: <br /> 4. Fr.Y. MOSC <br /> .EJTTtJ ORL''" PS�'f ,J3TrAt. <br /> State possible vector potenti<tl ?A necessary control: <br /> 5 . TOILET/BATH FACTT,TTF.S <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREMTOnS CPERATTCI�TnRY <br /> 7 . GENERAL SAIIIIAT ON <br /> State any problem.- not previously noted: <br /> 3 . P PU ,AT Ott DEMaTTY <br /> APpx. No . People per sq . mi. <br />