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Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no , explain : <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 /> FP <br /> V `' e e awd f�ti <br /> ,aQ- wry tJ <br /> Does existing or por sea use mak tiia �reil plater : Yes <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <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 VECTOR PO'rENTTAL <br /> State possible vector potential FA necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS 0/OPERATION HISTORY <br /> �0/1" e�a� <br /> 7 . GENERAL A141 ATTON <br /> State any problems not previously noted : <br /> 0A� <br /> 9 . POPULATION DENSITY <br /> Appx . No . People per sq . r,i . <br />