Prevent duplicating specific column from database table

This is more of a general PHP question than a WordPress one.

Use an array with the county as a key to group up your results.

$groups = array();
foreach( $results as $result ) {
    $groups[$result->county][] = $result;
}

var_dump or print_r on $groups to see how this groups up your results.

You can then loop over $groups, if there’s only one item in a group you output a single option, when there’s more than one then you make an option group.