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i . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system ' bomply with Ord . #549 : Yes No_ <br /> Unknown If no , explain: <br /> De ri a septi ins illation to be installed: ✓oil ��/ i��a <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well - Yes ido� Is well proper: <br /> Yes No State deficiency : _— <br /> Doeexisting or purposed use make tl)ifi well public water : Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Resul s Additional information or conlIfterlts <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No-'11�7' Service Area No . <br /> Other proposed disposal method : <br /> Potential problem : <br /> 4 . FLYMOSQUITO OR YLICTOR P'QMELIAL <br /> State possible vector potentiftl & necessary control : 4/�-VIXC <br /> 5 . TQLETIBATH FACILITIM <br /> No . & location existing . _=_. Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTM <br /> 7 . GENERAL SAP3I'TA'PI�� <br /> State any problems not previously noted - <br /> 3 . <br /> oted :3 . POPULATIQU DEITY. <br /> Appx . No . People per sq . mi . - <br />