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9 SiiiiACaE t <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 /> 2. WATER SUPPLY <br /> Is water suppliedby 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,�1 QSQUITOOR Vr^LTnR POTENTIAL <br /> State possible vector potential necessary control: <br /> 5 . TOTLETIBATH EArIL,iTE <br /> No. & location exieting: Additional <br /> facilities needed <br /> 6. PREVIOUS01!CRATION HISTnRY <br /> 7 . GENERAL SANITA'TTON <br /> State any problems not previously noted: <br /> $ . POPU .AT O14 D MSTTY <br /> Appx. No . People per eq. mi. <br />