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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes— No_ <br /> Does existing septic system comply with Ord . 0549 : 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 /> - 7&6/'L <br /> eficiency:— <br /> &hl« W'4 <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 /> 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 y CTO Eff_EETTAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FAC�1iJ1�' <br /> No . & location existing : /� Additional <br /> facilities needed <br /> 6 . PRFVTOUS OPERATION HTSTORY <br /> 7 . GENERAL SAP;TTATION <br /> State any problems not previously noted: _ <br /> 9 . pOP t ,ATION DENSTTVY <br /> Appx. No . People per r>cq. mi . <br />