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1. SKWAQ5 <br /> Distance to Public Sewers / Connection necessary: Yes X 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 /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No-Y—L 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 r <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No_ Service Area No. <br /> Other proposed disposal method: nuM <br /> Potential problem: A <br /> 4. FLY, MOSQUITO OR VF^TOR POTENTTAL. �1 <br /> State possible vector potential & necessary control:- <br /> 5. <br /> ontrol:5. TOI .F.T/BATH FAC ETES <br /> No. & location existing: ��� Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HTSTORY <br /> 7. GENERAL SANITATTON <br /> State any problems not Previously noted: <br /> 8 . POPULATION nENSTTY <br /> Appx. No. People per sq. mi. <br />