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1 . SEWAGF t <br /> Distance to Public Sewers r� Connection necessary: Yes Noy <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknowr If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private we'll : Yes Ll Is viell proper: <br /> Yes o State deficiency: <br /> Does existing or porposed use make this well pu is 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 c4sposal method: <br /> Potential problem <br /> 4 . =I- MOSQUITO QR VE;10R PSf1;NTIAL <br /> State possible vecto potentiFtl �.� necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVT0QS OPERAT IQN H �� <br /> 7 . Q +.N RAL SAP;IT `l.A j0N <br /> State any problem not Previously noted: <br /> 8 . POPULATIO14 DENSIT, <br /> Appx. No . People per rq . mi . <br />