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Distance to Public Sewers Conn ction 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 /> Z . RATER SUPPLY <br /> Is water supplied by private well : Yesy No Is dell proper: <br /> Yes_,L"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 commentsi <br /> P if<.c.1r 1"',1" <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick—up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,_ MOSQUITO OR VECTOR POf�I�Zltlil <br /> State possible vectorpo�;Lal. Fz necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIODE OPERATIQN HTSTORX <br /> 4Z 4 <br /> "Z-"4 <br /> 144 af <br /> 7 . GENERAL SANI'r,.g'f„ <br /> State any problem; not previously noted: _ <br /> 3 . POPULATION DE' `'T v <br /> Appx. No . People per rq. rr,i . <br />