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1 . SEWAGE P1 <br /> Distance to Public Sewers Connection necessary: Yes No4!!� <br /> Does existing septic system comply with Card. #5549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY+ ' <br /> Is wat supplied by private well : Yes �No Is well proper: <br /> Yes No S to det i'6hcy - 4-1. <br /> Does isting or porposed use make this well p bl c water: Yes <br /> No Sample of well water -taken: Yes Na 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 . FLY. MOSQUITO OR V E', M POENTIAL! <br /> State passible vector potential & necessary control! <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed � � <br /> 6. ^ OPERATION HIST <br /> 7 . GENERAL QABITATTON <br /> State any problems not previously noted:.._._ <br /> 8 . P F ATL�.Lj DENSITY <br /> Appx. No. People per sq. mi. <br />