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SEWAGE <br /> 1 Dice to Public Sewers �f 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 . MATER SUPPLY � <br /> Is water supplied by private well : Yes ` ilo Is well proper: <br /> Yes No State deficiency: <br /> Does pKisting or porposed use make this well public Water: Yes <br /> No ✓ 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-,- MOSQUITQ OR V 1i'.TC1 EC)MT?Ell <br /> State possible vector potentiitl necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVTOT]S OPERATION <br /> 7 . GENERAL SANITATI—Q <br /> State any problems not pr evlous-]. noted : _ <br /> S . E=1LATION DE i STTY <br /> Appx. No . People per Bq . mi . <br />