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i . SEWAGE <br /> A <br /> Distance to Public Sewers .r , 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 /> 2 . WATER SUPPLY <br /> Is wa'r supplied by private well : Yes V"' 'No Is well proper: <br /> Yes No State deficiency : <br /> Does ex, .ating 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: !n-a'r"p <br /> 4 . FLY, MOSQUITO OR Vr1:TOR PQ'T. N TA , <br /> State possibly: vector potential 8.c necessary control: <br /> 5 . TOiLET/BATH FACILITES p <br /> No. ec location existing: �b'� t" "1 41 JAJ Additional <br /> facilities needed <br /> 6 . PRF.VI0QS rP .RATION HISTORY <br /> 7 . GENERAL SANT' ATTON <br /> State any problems not previously noted : <br /> S . POPU LAT ON :y Ste" <br /> APpx. No . People per eq. mi . <br />