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1 . RRWAGR <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 SUPPL.Y <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does existing or porposed use make this well public water: 'les <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> N` <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 VECTt)R POTENTIAL <br /> State possible vector potential Fj necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed--- <br /> 6 . <br /> eeded __6 . PREVTOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION N� <br /> State any problems not previously rioted: <br /> 3 . POPULATION DENSITY <br /> Appy . No . People per coq . mi . <br />