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I SEWAGEi <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 SHPPI,`I <br /> Is water supplied by private well : Yes _ No Is dell proper: <br /> Yes.r No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> No Sample of well water tarsen: 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 . =L MOSQUITO QE VE^TOS P)fjIUILL <br /> State possible vector potentiftl & nacessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIST tt.Y <br /> 7 . QENERAL SAPUTATJON <br /> State any problems not previously notes--- <br /> 3 . EnPUL TIOPq DE NSTIv. <br /> Appx. No . People per sq. mi. <br />