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1 . S <br /> Distance to Public Sewers JV"'� Connection necessary: Yes_ <br /> Does existing septic system comply with Ord. #549Yes_ No- <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> Z. WATER SUPPLY "e" <br /> - - , T <br /> Is water-' supplied by private well : Yes �_ Is well proper: <br /> Yes Le'— No_ State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No L--S- <br /> ample of well water taken: Yes_ No-4,--Date taken <br /> Results Additional information or comments <br /> 3 . GARBAC • & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY-. MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> s <br /> 7 . GENERAL SANITATION <br /> State any problems not previou ly rs n eT- <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per sq. mi . <br />