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L 1 ! <br /> 00 ` <br /> 1 . <br /> Distance to Public SewerZ Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #549 : Yee No-- <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPTy <br /> Isw er supplied by Private well ! Yes .� No Is well proper: <br /> Yes, No State deficiency: <br /> Doe existing or porposed use make this well public water: Yes <br /> NoSample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> . Licensed scavenger Pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential Problem: <br /> 4 FLY, MCS Q!JITQ QR Y + F-Q1EH AL <br /> State possible vector potential. & necessary control: <br /> 5 . IITES j Additional <br /> No. & location existing: <br /> facilities needed <br /> 6 , <br /> 7 . GFNFRAL SANITATION <br /> State any Problems not previously mated: a <br /> g . P OPULATION DE EITY <br /> Apex No . People per sq. mi. y <br />