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SEWAGE <br /> Distance to Public SewersConnection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic instal ation to be installed: <br /> 2 . WATER SUPPL`I <br /> Is water supplied byprivate well : Yes �iio Is well proper: <br /> Yeses, .oto State deficiency : <br /> Does existing or porposed use make- this well public water: Yes <br /> No--L--'S-,ample of well water taken: Yes No " Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yef _fN't Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,- MOSQUITO OR VZ, TQ P_S?'MN=AL <br /> State possible vector potentiFtl & necessary control : <br /> . <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION =i p <br /> i +C <br /> 7 . QENERAL EAPL,L1' `l.A 20 <br /> State any problems nat Previously noted : <br /> 8 . EOPIJLATIO14 Drt `'I v <br /> Appx. No . People per rq. mi . <br />