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1 . SEWAGY <br /> Distance to Public Sewers Connection necessary : Yes Nd <br /> Does exi ting septic system ' comply with Ord , 0549 : 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 Y No Is well proper: <br /> Yee No—L 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: 1101%) <br /> Potential problem: AAWi <br /> 4 . FLY , MOSQUITO OR VB TOR P2[ENTTAL <br /> State possibly: vector potential P.c necessary control: <br /> ✓1 rA <br /> 5 . TOTT,FT/BATH FACILITF� f.:. i�- Additional <br /> No . & location existing: <br /> facilities needed <br /> 6 . PRRVTOnS OPERATTON HISTORY <br /> 7 . GENERAL. SANT::A'rT0N <br /> State any problems not previously noted: <br /> g , popULAT ON DEYSTTY <br /> Appx. No . People per an. mi . <br />