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1. SKWAGR <br /> Distance to Public Sewers Connection necessary: Yes Nov"- <br /> Does existing septic system comply with Ord. #549 : Yes No11T <br /> Unknown If no, explain: . <br /> xplain: . <br /> Describe septic in tallation to 'be installed: cco�-di!, <br /> 2. WATER SUPPLY <br /> Is wat,.r supplied. by private well: Yes No Is well proper: <br /> Yes ✓ No State deficiency: <br /> Does a sting or porposed use make this well pubIie crater: Yes <br /> No I Sample of well Water taken: Yes No ✓ Date taken <br /> Results - Additional information or comments <br /> 3 . GARBAGE A REFUSE <br /> Licensed scav er pick-up: Yes No Se vice Area No. <br /> Other proposed poral method: <br /> Potential problem: <br /> 4. FLY. MOSQUITO OR V O �' <br /> State possible vector pa entiftl & ne scary control: <br /> 5 . TOILET/BATH FACILTIES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRRVIORS OPERATIOM HISTORY <br /> 7 . GENERAL. SANITATION <br /> State any problems n t previously noted: <br /> 8 . POPULATION DEYSITX <br /> Appx. No. People per aq. mi. <br />