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�. SRWAGR <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord. »549 : Yes_ No_ <br /> Unknown It no, explain: <br /> Descri c inata a 'be installed: <br /> 2. WATER SUPPLY <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: 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 VMCTOR PO'f ,.NTTAL <br /> State possible vector potential & necessary control: <br /> 5. TO , .T/HATH FAC TES <br /> No. ec location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPRRATION HISTORY <br /> d.�. f G r C ✓ 2 2--a" Z _?Lo its <br /> 7. GENERAL SANITATION <br /> State any problems not Previously noted: <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per aq. mi. <br /> rA-46 ,A ✓ c a ; A a ,' <br />