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1 . SEWAGE <br /> Distance to Public Sewers -A—) - 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 . WATER SUPPLY <br /> Is water' supplied by private well : Yes " No Is well proper: <br /> Yes -' No State deficiency .- <br /> Does <br /> eficiency :Does existing or porposed use make this well pubpc water: Yes <br /> No Sample of well water taken: Yes No ✓ Date taken <br /> Res/ults / Additional information or comments <br /> !f# 2 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Qther proposed disposal method : <br /> ;nOSOUTTO <br /> ial problem : <br /> 4 . JZ,TOR ELiTrNTIAL <br /> State ssible vector potent,in1 & necessary e trol: <br /> 5 . T Q <br /> No . & location ex ting: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H <br /> 7 . GENERAL SANITATTZON <br /> State any problems not previousXrnited- <br /> 8 . <br /> DENSITY <br /> Apn . No. People per Bq. mi . <br />