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1 . SEES <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 /> Describeepticinstallation ion to be installed: <br /> : <br /> , <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes -4 No Is well proper: <br /> Yes, ._ No State deficiency: <br /> Does .existing or porposed use make this well public water : Yes <br /> No—,4_ Sample of well water taken: Yes No--Z- DNteaken <br /> ResultB Additional information or comments ��✓ �� <br /> ,.n%c% ,' ,e•. �� ., rg''/.�; i �x y,, �:'f ''s`/.IG �i.✓t �r,4!/�f'!f•► � <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: __ _ <br /> 4 . FLYS MOSQUITO OR VECTOR PO'T'ENTIAL <br /> State pos -ible vector potential & necessary control <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing : �•1_ Additional <br /> facilities needed____ _ <br /> 6 . PREY//MOUS O ERATION HISTORY <br /> 7 . GENERAL SANI' All-M <br /> State any problems not previously rioted: <br /> S . POPULATION DENSITY <br /> Appx . No . People per F3q. mi .�,�f <br />