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Distance to Public Sewers Connection necessary: Yes No._,_, <br /> Does existin8 '., septic system comply with Ord. #549 : Yee No_ <br /> Unknown -If no, explain- l <br /> k k . <br /> Describe septic installation to 'be installed: <br /> 2. WATER..,,,MITPPLY <br /> Is water supplied..`by private well : Yes No Is well proper: <br /> Yes No - State`d'eficiency: <br /> wo <br /> Does ex}sting or porposed use make this well public water: Yes <br /> Nom Sample of well water taken: Yes No "�Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFQSE <br /> Licensed scavenger pick--up: Yes Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR Vr,-,-,TOR_PS[j;,M.TIAi; <br /> State possible vector potential 8i scary control: <br /> 5 . TOILET/BATH T!ACiF,ITES <br /> No. & location existing: Additional <br /> facilities needed <br /> S. EREMIQna OPREATIOU HISIQRX <br /> 7. GENERAL SA?d7TATTc7N <br /> State any problems not previously noted: <br /> 8 . BORULATION DXNSjjj <br /> Appx. No . People per .sq. mi .__ .. <br />