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1 . SEWAGF <br /> Distance to Public Sewers 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 /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes 111 Is yell proper: <br /> Yes No State deficiency : <br /> Ait , ! <br /> Ake <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 Lei REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposa method: <br /> Potential problem: <br /> 4 . ZLLy_L MOSQUITO Q$ VEQTOR PSfjjaT_TAL <br /> State possible vector potentiFtl necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No. ec location existing: — Additional <br /> facilities needed _ <br /> 6 . PREyions_ OPERATIC_ ij H ZT= <br /> 7 . GENERAL SANI'r,AT ON <br /> State any problems nob previously noted : <br /> 8 . pn jLATION DENSITY, <br /> Appx . No . People per r_.q . rni . <br />