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1 • MAGE �� �� <br /> Distance to Public Sewers 1'�f=-- Connection necessary: Yes No- <br /> Does <br /> o-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 wate-r supplied by private well : Yes �iio Is viell proper: <br /> Yes No State deficiency : <br /> Does e sting or porposed use make this well public water: Yes <br /> No Semple of well water tarsen: Yes No -----Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scaven er pick-up: Yes No Service Area No . <br /> Other proposed posal method: <br /> Potential problem: <br /> 4 . L MOS-)UITO OR V ^._0 PO'f2 <br /> State possible vectorp Nntiftl nec scary control: <br /> i <br /> 5 . TOILET/BATTI FACILITES <br /> No. & location existing: Additional <br /> facilities needed- <br /> 6 . <br /> eeded6 . PREVTQQS OPERATTON HIS RY <br /> 7 . GENERAL SANI;r '1,A ' O <br /> Stat; any problem: � t previously noted : - <br /> 3 . <br /> oted : _3 . POPULATION DntISTIX <br /> Appx. No . People per rq. mi . <br />