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1 . 9 EWAG.E <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 /> Z. WATER SUPPLY <br /> Is water supplied by private well : Yes Ido Is well proper: <br /> Yes No State deficiency: <br /> Does existing 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 . CARBAGF. & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR V ^TO pQ):rrNTTAL <br /> State possible vector potentiFtl & necessary control: <br /> 5 . TOTLET/BATH FACILITES <br /> No. ec location existing: Additional <br /> facilities needede <br /> 6 . PREVTOnS OPERATIOU HISTORY <br /> 7 . GENERAL SANTIATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DRNSTTY <br /> Appy. No. People per eq. mi. <br />