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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 /> Ire- <br /> 2. WATER SUPPLY00, <br /> - <br /> Is water supplied �:�Tprivute 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 A REFUSE <br /> Licensed scavenger pick-up: Yes N Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: 77 <br /> 4. FLY, MOSbUITO 08 V-^.TnR PurriNTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVIOna CPERATION HISTOR <br /> 7. GENRRAL SANTIATION <br /> State any problems not previous - <br /> 3 . POPLJLATIOtd-DENSTTY <br /> APpx. No . People per .eq. mi. <br />