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l . SJiii A Q E / <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 /> Descria sept c i stallati n to 'be installed: /j `, <br /> z - <br /> Z . WATER SUPPLY <br /> Is water .supplied by private well : Yes No Is viell proper: <br /> Yeses State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No �— Sample of well water tarsen: Yes Nom Date taken <br /> Results Additional information or comments �%n <br /> S . GARBAGE & REFUSE <br /> Licensed scavenger pick--up: Yes No Service Area No. <br /> Other proposed disposal method: -� <br /> Potential problem: _ <br /> 4. FLY. MOSQUITO QR V i^.TO PO'.r2113TTA <br /> State possibly: vector potentiftl & necessary control: <br /> 5 . TOTLFT/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6. PREVIOUS CEBRAT ON HISTngX <br /> 7 . GENERAL SAIIIIATION <br /> State any problems not previou ly noted: <br /> S . POPLILATI014 DE,NSTTY <br /> Appx . No . People per eq . mi . <br />