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i <br /> Distance to Public Sewers LLA Connection necessary: Yeses No <br /> Does existing septic system comply with Ord. #549 : Yeses No_,... <br /> Unknown If no, explain: <br /> 7(P- <br /> Describe septic installation to *be installed: <br /> 2 . WATER SUPPLY <br /> Is wafer supplied by private well : Yes �No Is well proper: <br /> Yes No State deficiency: <br /> Does �-isting or porposed use make this well Pu <br /> b]yic nater: 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 S vice Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. M050UITQ OR V E^. P0'f21NTTA <br /> State possible vector otential nec sary control: <br /> i <br /> 5 . TOTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVTQnS OPERATION HISTORY <br /> 7 . GENERAL SANITATTON <br /> State any problems not previously noted: <br /> 3 . POPU .A IOIJ DENaTTY <br /> Appx. No . People per eq. mi . <br />