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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 /> 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 CO-. 42 <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FILL-, MOSQUITO OR y L^ID ECUENTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HIST- <br /> Adj YI r L Le ZAL2_'1� <br /> 7 . GENERAL SA14ITATION <br /> State any problems not previously noted:- <br /> 8 . POPULATIQ14 DENSITY <br /> Appx. No. People per sq. mi . <br />