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1 . . FWA ,E <br /> Distance to Public Sewers / Ciel Connection necessary : Yes_L�No_ <br /> Does existing septic system comply with Ord. #549 : Yes_ No-[ <br /> Unknown If no, explain: <br /> NU _ G S FYI <br /> Describe septic installatio to 'be ialled: <br /> Ar' <br /> Ag <br /> a dcr <br /> - O <br /> 2 . WATER SUPPL7 <br /> Is water supplied by private well : Yes _ No� Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does existing or porposed use make this well public water: 'les / <br /> No Sample of well water taken: Yes_ No— Date taken <br /> Results Additional information or comments <br /> c <br /> 3 . <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem`� <br /> 4 . F .Y . MOSQUITO OR V OR POTENTIAL <br /> State possible vect r potential & necesgary control : <br /> 5 . T4 ,F.T/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRFVIOUS f PERATIOM HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9 . POPULATTOIJ DENS?TY <br /> Appx . No. People per eq . mi . <br />