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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 septic installation to be installed: <br /> Z . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : — <br /> Does existing or purposed 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 mehod - <br /> s_ <br /> Potential problem, L, � -- <br /> 4 . FLY M23DUIM OR 11-3 m ) ZCII�.UUIE L <br /> State passible vector �otentiftl & necessary control <br /> 5 . 0 ET/BATH Fuka=Ma <br /> No. & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HST <br /> 7 . GENERAL SANITA:L' M. <br /> State any problems not previou.e:l.y oted: _ <br /> 8 . POPULATIc�j�1MiaLT_ \ <br /> Appx . No . People per sq. mi ._— <br />