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1 . SRWAGR <br /> Distance to Public Sewers Connection necessary : Yes_ Nom <br /> Does existing septic system comply with Ord. 0549 : 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 X- Sample of well water taken: Yes_ Nox Date taken <br /> Results Additional information or comments �IEFC <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 VRCTORO'P �.Nr TTAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FAC TRS <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : s-dF <br /> 9 . POPULAT ON nRNSTTY <br /> Appx, No . People per eq . mi . .is6��nci.Gf,�- ✓���' �� <br />