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1 . 6EWAGF <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 : Iles -S<-, No__ Is well proper: <br /> Yes No-- State deficiency: <br /> Does e listing or porposed use make this well public water : Yes <br /> NoSample of well water taken: Yes No V Date taken <br /> Results Additional information or comments <br /> 4, <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up; Yes No__ Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: — <br /> 4 . EM- MOSQUITO OR <br /> State possible vector potential & ece ry control : <br /> 5 . TQI ,_LET/BATH FACILI'N' <br /> No . & location existiDg : ZAdditional <br /> facilities needed _- <br /> 6 . PREVIOUS OPERATIONHIMM-E <br /> 7 . GENERAL _SAT " 7-. <br /> State any problems not previously noted: ------ <br /> S . <br /> oted: .—S . POPULATIQN DENSITY <br /> Appx . No. People per sq. mi ._—_ <br />