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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 do Is well proper: <br /> Yes iia State deficiency: <br /> Does existing or pornosed use make this well public water: Yes <br /> No Sample of well water taken: Yes Na Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -- -_ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY,__MOSQUITO__L7R Y ,-,T� -nrt_ OTCNTIAL_ <br /> State possible vector pvtentirtl & necessary control.: <br /> 5 . TQILET B/ ATH EACH ITEa <br /> No. & location existing: Additional <br /> facilities needed a <br /> 6 . eR,EYIORS CPERATTON HLST_OgX <br /> 7 . GENERAL SAtlIT : to <br /> State any problems not previou l noted : <br /> 3 . PPS11LATTON D 2TI:-,r <br /> Appx. No . People per sq , mz.. <br />