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1 . 2,EWA(' <br /> Distance to Public Sewersl/� ��'Connection necessary: Yes Nd <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> k,.,4 t4. 4�C .14- <br /> Describe s pti0 itst 11 tion to be installed: /-- <br /> 07 4l0 C�/! ''r �E�i�Od/'�,CJr ,fi/i� G� <br /> 2 . NATER SUPPLY <br /> Is water supplied by private well : Yes No,z Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of we wa er 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 VECTOR POTENTIA <br /> State possible vector potential & necessary control : �;;!e <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : '°"'` Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously rioted : <br /> 8 . POPULATION DENSITY <br /> Appx . No. People per sq . <br />