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1 . SEWAGE n�� <br /> Distance to Public Sewers — Connection necessary: Yes No Y <br /> Does existing septic system comply with Ord. #549 : Yes-Z- No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is wa er supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency ! <br /> Doe xisting or porposed use make this well pu lic water: Yes <br /> No Sample of well water taken: Yes NoT Date taken <br /> Res 1 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 y Q EfffIR`aTI L <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACILI'I'E15- <br /> No . & location existing= - "'L_-_ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISME <br /> 7 . GENERAL SANITA`. -IR <br /> State any problems not previouc,ly noted: <br /> 8 . E'OPULATIQN DEI SIT—Y <br /> Appx. No. People per sq. mi .- <br />