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SEWAGE <br /> Distance to Public SewersrIO'Lp 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 /> ' <br /> 2 . WATER S ]PPT,Ti � <br /> Is wat supplied by private well : Yes v,, No Is well proper- <br /> ,,r <br /> State deficiency : __ <br /> Doex ing or porposed use make this well public water: Yes <br /> Noes Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments-- <br /> 3 . <br /> omments3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . ZLYLL MOSQUITO OR Y ,7 ? ' )MRT1AL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITA'1' M1 <br /> State any problems not previously noted- - <br /> S . <br /> oted.: `8 . POPULATIQN DF1, 11 <br /> Appx. No. People per sq . ml . _ <br />