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6 SRWAGR <br /> Distance to Public Sewers � Connection necessary: Yes_ No_ <br /> Does existing septic system comply w't} Ord. #549 : Yes_ No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: aes <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes NoZ. Is well proper: <br /> Yes_ No_ State deficiency: .,e�E <br /> s a <br /> s <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes_ No,,� Date takenT_ <br /> Ra� ditio}ia� information or comments Gin <br /> f� �� t E•C d.. l�lrf/�.C�.�•f�nd/ fOs-.r f� e Fl.� <br /> 3 . GARBAGE & RRFUSE VAe <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR Vr_sTOR POT I.N� TTAL, 4� <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES14� <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRRVZnas f)PCRATION HISTCIRY <br /> 7. GENERA . SANITATION <br /> State any problems not previously noted: <br /> S . POPULATION DENSITY <br /> Appx. No . People per eq . mi.4L�'z <br />