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1 . SEWAGE <br /> Distance to Public Sewers Connection ii,, .assary: 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 /> Z . MATER SUPPLY <br /> Is water supplied by private well : Yes �-L No Is well proper: <br /> Yes No State deficiency: <br /> 1 &YI 0Ir <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 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . F. X . MOSQUITO OR VZfjQR PCt'j'2NTIAL <br /> State possible vector potentiftl ez necessary control: <br /> 5 . TO .T/ ATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SLNITATION <br /> State any problems not previously noted: - <br /> 8 . <br /> oted: _8 . POPULATION DENSM <br /> Appx. No . People per cq. mi . <br />