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2 ; <br /> t. SEWAGE <br /> w Distance to Public Sewers AI Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No <br /> Describe septi installation to be installed: <br /> F <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper-, Yes No <br /> tate deficiency: ' <br /> r <br /> Does existing or proposed use make thi well pu lac wat Yesc �No Sam le of well <br /> water taken: Yes No Date taken Results <br /> l Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> PotentW problems: <br /> ` 4. FLY MOSQUITO. OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILETBATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8. POPULATION DENSITY <br /> ' Appx, number of people per square mile <br /> !k{'� <br /> 1T <br />