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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No/`,� Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Res Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Lic sed scavenger pick-up: Yes No Service Area No . <br /> Other' roposed disposal method: <br /> Potent�l problem <br /> 4 . ELY. MOSQUITQ OR VE^.TQa_ZC)r=AL <br /> State possibl vector potentiftl & necessary control : <br /> 5 , TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIO(IS rPI RATION HISTOEiY <br /> 7 . GENERAL SAI 'r,}, TION <br /> State any problems not previously noted- - <br /> 3 . <br /> oted: _3 . ROPULATION DENSTTY <br /> APpx . No . People per sq . mi . <br />