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1 . IMAGE -1r^ � <br /> Distance to Public Sewers ' Connection necessary: Yes_ No_ <br /> Does existl>hg septic system comply with Ord'. #549 : Yes_ No_ <br /> Unknown ✓ If no, explain! <br /> Nd s,�Q c <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is watyr supplied by private well: Yes No_ Is well proper: <br /> Yes✓ No_ State deficiency: <br /> Does,�ssxietine or porposed use make this well pul�kic water: 'les <br /> NoL Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ NoService Area No. <br /> Other proposed disposal method: <br /> Potential problem! <br /> 4. FLY. MOSQUITO OR V1^ O <br /> State possible vector po entittl y <br /> necessary control: <br /> 5. TOT ,F.T/BATH FACTT,TTF.S <br /> No. & location existing: A Additional <br /> facilities needed <br /> 6. pggVTOng Opgg TOM HTsTn <br /> 7. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTTY <br /> Appx. No. People per eq. mi. <br />