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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes Nq_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic install ion to be ins ailed: <br /> Z . WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper : <br /> Yes Nov_ 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 . FLYL MOSQUITO OR YZ_QLQE__F_CiTENTIAL <br /> State possible vecto.c potential & necessary control - <br /> 5 . <br /> ontrol :5 . <br /> No. & location existing' Additional <br /> facilities needed --- <br /> 6 . PREVIOUS OPERATION HI�iTOf(Y <br /> 7 . GENERAL SA 7IZ `1A.:Ts2L <br /> State any problems not,t; previously noted: ___ <br /> 3 . POPULATIQN DmaLTY <br /> Appx No . People per F:q. mi .- <br />