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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary . Yes No>" <br /> Does existing septic system comply With Ord , #549 : Yes No4. <br /> Unknown If no, explain: + <br /> Descri a septi installation to 'be installed: -yf���� '� <br /> J'Ei is 1'y✓ <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: <br /> Yes No State defi4 <br /> ciency: ae ����� � <br /> Does existing or porpo8ed 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 4/� <br /> Licenced scavenger pick-up: Yes Nom. Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSOUITO OR V T02 PO'rrNT A <br /> State possible vector potentirtl & necessary control: �< <br /> 5 . TOILET/BATH FACILITES /J <br /> No. & location exieting: Additional <br /> facilities needed <br /> 6 . PREVIOnS OPERATION HISTORY <br /> 7 . GENERAL SANIT TA ION <br /> State any problems not previously noted: <br /> 8 . POPULATION DE{ SrTy <br /> APpx. No . People per aq . m i . <br />