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1 . SRWAGK <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 /> 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 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 V1,^.TQR PO'CENTIAL <br /> State possible vector potentiztl necessary control: <br /> a . TOILET/BATH I;AaILITF.,.,Z <br /> No . & location existing : Additional <br /> facilities needed -- -- <br /> 6 . PRFV Ons 0, R. i TSTnE?Y <br /> 7 . GENERAL SANITATI n <br /> State any problems not Previously noted: <br /> $ . BOBUL, Dr'p�,_ <br /> Appx. No . People per sq. m i . <br />