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1 . SEWAGE <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 . MATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <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 . =�,_ M SQ 1ITQ OR V ,^.TOS ZCi'rjaLTjAL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TQTLET/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREyTona Op .RATION HISTO r <br /> 7 . ORNERAL SAtLj '1'Tc_N <br /> State any problems not pre•,riottsly noted: _ <br /> 8 , PO > LATIO14 DE tISTTY <br /> Appx. No . People per sq. mi . <br />