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1 . SEWAGE <br /> Distance to Public Sewers �k Connection necessary: Yes No '� <br /> Does existing septic system comply with Ord. #549 : Yes No <br /> Unknown If no, explain: <br /> Describe septic insta la t on to 'be installed: N < . <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes ✓ No State deficiency <br /> Doessting 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 . MOSOUITO OR VrQ TOR FQ'[C TTA <br /> State possible vector potentiftl 8A necessary control: <br /> 5 . TQTT,F,T/BATH FACILITES fJ <br /> No. & location existing: k / Additional <br /> facilities needed <br /> 6. PREVTQna OPERATION HISTORY91 <br /> ! // <br /> 7 . GENERAL SAr1TITA TON <br /> State any problems not previously noted: <br /> 3 . POPULATION D HSTTY <br /> Appx. No. People per req. mi. <br />