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i . SEWAGE <br /> Distance to Public Sewers - Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord. 0549 : 'les— No_ <br /> Unknown IE no, explain: <br /> Describe septic installation to be installed: � / tee' <br /> b n "AA-; P4Z, r,ul <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 /> or <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes / No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY . MOSQUITO OR V ECTOR POTENTTA . <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILITES Additional <br /> No. & location existing: <br /> facilities needed <br /> 6 . PRFVTOUS OPERATION HISTORY <br /> Z f fig/ <br /> -7 <br /> 7 . GENERAL SANTTATION <br /> State any problems not previously noted : �� y <br /> 9 . POPU ,ATION F.NSTTY <br /> Appx. No. People per eq . mi . <br />