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2. a <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, WATER 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 tilis well public water: Yes <br /> No Sample of well water taken: Ye$ Na Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE &- EEEITSE <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4. <br /> roblem: <br /> 4. FLY. MOSQUITO QE _Y_ OR PQ'rENITAL <br /> State possible vector potential & necessary control: <br /> 5 . nEACTLTIFS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. EHEVT( US OPERATION HISTOEM <br /> 7 . <br /> State any problems not previously noted: <br /> 8 . F—OPULATTOM DEYSITY <br /> Appx. No. People per sq. mi. <br />