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1 . S R WAC E <br /> Distance to Public ewers 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 r r <br /> Is water supplied by private well : Yes/--' No_ Is well proper: <br /> Yes _ State deficiency: <br /> Does existing or porpoeed 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: Yeses No_ Service Area No. <br /> Other proposed disposal method/' <br /> Potential problem: <br /> 4 . F .Y. M SOUTTn OR VCQT0R POT WTA . <br /> State possible vector potential & necessary control: <br /> 5 . TOILF.TlBATR FACILrES <br /> No . ec location existing: Additional <br /> facilities needed <br /> 6 . PRF.VrOUS OPERATION HIi O <br /> Ole A r Q <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: — -- <br /> 3 . POPULATION DENSTTY <br /> Appx , No . People per sq. mi . -- <br />