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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes N94- <br /> Does existing septic system comply with Ord. #549 : Yes; No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: --✓�7g��' <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes ' No Is well proper: <br /> No State deficiency : -.�,­e� <br /> Does existing or porposed use make this well public water: Yes <br /> NoSample of well water taken: Yes No.. V Date taken <br /> Resu is 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. FLY . MOSQUITO OR -YRQ_TOR PQ'[2,NTTA <br /> State possible vector potential +.c necessary control:�ir� <br /> 5 . TOILET/BATH FACTLITE <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRFVTOnS OPERATION H STORY <br /> 7 . GENERAL SAITTIATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTTY ' <br /> Apex. No . People per sq. Mi. <br />