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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 _ 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 � No Is well proper: <br /> Yes No State deficiency : <br /> Doe xi ti or porposed use make this well public water : Yes <br /> NoSample of well water taken: Yes NoDate taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE 1-1 <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY MOSQUITO OR Y QMQ Z2r=, AL <br /> State possible vector potential & necessary control : _ <br /> 5 . TOILET/BATH FACILI7 S <br /> No. & location existing:- � Additional <br /> facilities needed <br /> 6 . PREVIOUS OPEERRATION HISTfjBj <br /> 7 . GENERAL SA14ITf TION / <br /> State any problems not previously noted ., �/� — Com` c�9�✓ <br /> 8 . POPULATIQN DENSIT - <br /> Appx . No . People per sq . mi . <br />