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f. SKWAQK <br /> Distance to Public Sewers Connection necessary: Yes NOL <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. HATER SUPPLY <br /> Is hater suppliedby private well : Yes iso Is well proper: <br /> Yes `- No State def icirncy: <br /> Doe <br /> xisting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . QARBAGE & REFUSE <br /> Licensed scavenger pick--up: Yes \-/ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MOSQUITO OR YI`�T�_EQ'r.j:,N.TTAL <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH FACILITES <br /> No. & location: existing N Additional <br /> facilities needed <br /> b. PRRYTO TS CRERAjT—M HISjQEa <br /> r " <br /> 7 . GENERAL SANITATTQN' <br /> State any problems not previously noted: <br /> 8 . P.OPULATIOi DEITY iv <br /> Appx. No . People Pr r .coq. m i. <br /> r <br />