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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, MOSQUITO OR VE^.T ) ECi'r ENTIAL <br /> State possible vector potentiFtl ?z necessary control : <br /> 5 . TrOILET/BATH FACILITES <br /> No. & location exi.-ting: _ __ Additional <br /> facilities needed _ <br /> 6 . PREVIOU,E OPERATION HISTORY <br /> 41 <br /> 7 . GENERAL SAP�T'r `1.19 'TCN <br /> State any problem: not Previously noted: — <br /> 8 . POPULATION DENSITY <br /> Appx. No . People per rq. mi . F - <br />