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8l Ja C7.dld F <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 /> V <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 thii3 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 . FLYS MOSQUITO OR V E^TQ) ECi'f aNTT_AL <br /> t . <br /> State possible vector potentiFtl ?.c necessary control : <br /> ,f <br /> 5 . TOILET/BATH FACILITES <br /> No . & location exiting : _ Additional <br /> facilities needed _ <br /> 6 . PRFVTOf1S (-,pERATIInN HjsTnFiX <br /> T <br /> 7 . GENERAL SAPJjjA 'TON ' <br /> State any problems not prevlously noted : b <br /> 8 . F=MAT I OPd DENSTIX <br /> Appx . No . People per sq . mi . <br />