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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 septi installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ;�S. No Is well proper; <br /> Yes >" No State deficiency : �1:7 7e;l <br /> Does existing or porposed use make this well public water: Yes <br /> No's Semple 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 VECTOR PQfEttTIAL <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOT ,"T/BATIT FACILITES <br /> No . ec location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATIO" ;TO +' <br /> 7 . GENERAL SANIT `l�H <br /> State any problems nat Previously noted :�v�c <br /> 8 . PMILATION DIiiL ST v _ i r <br /> Appx. No . People per sq. m i . <br />