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1 . SFWAGE <br /> Distance to Public Sewers A Connection necessary: Yes Nom <br /> Does existing septic system comply with Ord . 0549 : Yes7— No_ <br /> Unknown If no, explain: <br /> Describe septic instal lion to be instplled: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No–Z– Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does existing or porposed use make- this we'll public water: Yes— <br /> No )( <br /> esNo ( Sample of well water taken : Yes_ No_ Date taken <br /> Results Additional information or comments <br /> GUe l/ 4 "'Lf <br /> 3 . GARBAGE & R .F IS . <br /> Licensed scavenge pick-up: Yes_ No_ Service Area No . <br /> Other proposed di <br /> s osal method: <br /> Potential problem: <br /> 4 . FLYS MOSQUITO OR VC,T PO''r-EB.T-6L <br /> State possible vectorotentirtl & nee nary control : <br /> 5 . TOTLLET/BATH FACILITES <br /> No . & location existing : V Additional <br /> facilities needed <br /> 6 . PRFVT0f1S OPERATION HISTORY <br /> 7 . GENERAL SANTT TION <br /> State any problems not eviousl.y noted :_ <br /> 9 . pOPULATION DENSITY <br /> Appx . No . People per sq. mi . <br />