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L . 1233IIAGE a 9 <br /> Distance to Public Sewers �" Connection necessary: Yes_ No <br /> Does existing septic system comply with Ord . 1$549 : Yes_ No <br /> Unknown If no, explain : <br /> ov, r ,)f <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No Is well proper: <br /> Yes_ No_ State deficiency : <br /> usc make this well public water: Yes <br /> Does existing orCpcp s d <br /> No Sam le of w wafer taken: Yes_ No✓ Date taken <br /> Results k Additional information or comments <br /> 'w will c <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FLY. MOSQUITO OR VROTOR POTENTTA <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRF.VIOOS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . PnP[II.ATION DENSITY <br /> Appx. No . People per eq. mi . <br />