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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yeses No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is w�it�er 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 /> 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 . ELY. MOSQUITO OR VECTOR ECIMI .TIAL <br /> State possible vector pote tiftl & necessary control : <br /> 5 . TOIL .T/BATH FACT ,IT .S <br /> No . & location existing: — rn�N` �1 ✓�f',-�^' Additional <br /> facilities needed b <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 1U.. I&A,- <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 5 . POPULATION DENSTIY <br /> Appx . No . People per sq. mi . <br />