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1• SRWAGE <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 /> Des e i e septic in tallation to be insta led: <br /> yr ad 464 2 <br /> 2. WATER SUPPLY <br /> Is water supplied- by private well: Yes t No_ Is well proper: <br /> Yea 4- leo_ State deficiency: <br /> Does e?yiating or porposed use make this well public water: `les <br /> No ✓ Sample of well water taken: Yes_ No/ Date taken <br /> Results Additional information or comments7' z( - -iy % A-/ <br /> 3 . GARBAGE & RRFUSE f <br /> Licensed scavenger pick-up: Yea_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR VECTOR POTrENTIA . <br /> State possible vector potential & necessary cont <br /> 5 . TO • .T/HATH FACTLTTES <br /> No. & location existing:---- Additional <br /> facilities needed <br /> 6. PRRVTOnS OPERATION HISTORY a <br /> 7. GENERAL SANICATTON <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No. People per eq. mi. ' <br />