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SSFWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yea No_. <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is Nater supplied by private well : Yes 'rho 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 V,,,QTnR POT21 MAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILFT/BATH FAOTU TFS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PR .VIOnS OPERATION HTSTORY <br /> 1� (' �. - . <br /> 7 . GENERAL SANT` ATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTTY /— <br /> Appx. No . People per sq . mi. <br />