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1 . 2EWAGE <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 /> (7 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes �` No Is well proper: <br /> Yes ,;� No State deficiency : <br /> Do(T 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 L No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =� MOSQUITQ OR VZl TO EC)M <br /> State possible vector potentiFtl Fz necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing. Additional <br /> facilities needed _ <br /> 6 . PREVIOn^ ORFRATION H=n D=t <br /> 7 . GENERAL SANI'1'AU-21 <br /> State any problem: not previously noted: - <br /> 14 <br /> oted: _ <br /> t: <br /> 3 . ROP LATION DENSTIX <br /> Appx. No . People per Bq . m i . ' <br />