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i . <br /> Dice to Public Sewers - Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, ex,.p�l�ain: <br /> ��-�C'J/7/ • r - <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is wsupplied by private well : Yes `'�r <br /> a .er No Is well proper: <br /> Yes No State deficiency: <br /> Does ex ting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes Nom-Date taken <br /> Results Additional information or comments <br /> f / ler r,A'• ? <br /> �� ► <br /> 3 . GARBAGE(A­ <br /> R-FUSE �� <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method = <br /> Potential problem: <br /> 4 . FLY L MOSQUITO OR IECTOR POTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . T ILET/BATH FACILI7.'ES <br /> No. & location existing : Additional <br /> facilities needed -�- <br /> 6 . PREVIOUS OPERA CORY <br /> 7 . GENERAL SAKI. 7`�A 'ION <br /> State any problems not previously noted: .--' <br /> 8 . POPULAT I QN DE JJ T L <br /> Appx. No . People per sq . mi . <br />