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i <br /> Z . SEWA Q F <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 Lir private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does /existing or porposed use make this wellp blic water : Yes <br /> No Sample of well water taken: Yes NoDate taken_. <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . My-L MOS Q U I T 0 QR V1I' ) Z2M TIAL � �t <br /> State possible vector pcjtentihl �i necessary control : <br /> 5 . TOILET/BATH FACILITY <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION H=f <br /> 7 . GENERAL SAT 'T " M <br /> State any problems not previouGly noted: <br /> k4– <br /> S . POPULATIQN DEiiSITY <br /> Appx . No . People per sq . m:i. . <br />