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1 . SSW ' <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 : Yes No_ Is well proper: <br /> Yee No_ State deficiency : <br /> Does existing or porposed use make this we'll public water: Yes <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Res lts Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No_ Service Area No . <br /> Other proposed disposal method: <br /> tential problem : <br /> 4 . FLYS MQS6UITO OR VECTOR POTENTIAL <br /> State Possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location exioting : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERA ION HISTM <br /> 7 . GENERAL <br /> State any probSANI!h'U s r,ot previously noted- <br /> , .`` • <br /> r e <br /> 6 . POPUL��I�N DENSITY <br /> Appy: No . People per sq. mi ._ <br />