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-6 <br /> � . SEWAGE <br /> Distance to Public Sewers 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 /> trY �fliti»'1 ° 7 - 75 1' <br /> 2. WATER SUPPLY <br /> Is water 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 . =, MOSQUITO OR V ,-T-C Z2rMTIAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES) <br /> No. & location existing : — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HI)TOR <br /> 7 . GENERAL SAPU A'1'I01i <br /> State any problem: not previously noted : <br /> 9 . POPULATT_O14 DEISTTY <br /> Appx. No . People per req. mi . <br />