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I <br /> 1. SEWAGE <br /> Distance to Public Sewers Sof Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes No <br /> Unknown If no, explain: <br /> /Va _e <br /> Describe septic insta�lation 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�isting or porposed use make this well pub is water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> - <br /> 8 . GARBAGE& REFUSE <br /> Licensed scavenger ick--up: Yes No Service Area No. <br /> Other proposed dispos 1 method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR VEQT!22�&rRNTTAL <br /> State possible vector pote t al R.c nece nary control: <br /> 5 . TOILET/BATH FACTL�TTE <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS opgRATTONl HTslnRY <br /> 7 . GENERAL SANI TTON <br /> State any problems not previously noted: <br /> 8 . POPULATT014 DENSTTY <br /> Appx. No . People per eq. mi . <br />