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1 . S]EWAG F <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 /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes L-L No Is well proper: <br /> Yes No State deficiency : <br /> Doeistina or porposed use make- this well public water: Yes <br /> - <br /> No <br /> a <br /> No Sample of well water taken : Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .F lSF <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem <br /> 4 . FLY MOSQUITO Thi OR VEIC-2 EC)MMAL <br /> State possible vector potentiftl 84 necessary control : <br /> 5 . TQTT,FT/BATH FACT1,TTES <br /> No . & location existing! Additional <br /> facilities needed <br /> 6 . PREVTOT72 OPERATION HI ST.QRY <br /> 7 . GENERAL SANITA L(_) <br /> State any problem"s not previously noted : _ <br /> 8 . POPULATION DENSTIv <br /> Appx . No . People per 6q . mi . <br />