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R -2 <br /> 1. SRWAra <br /> Distance' to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. 0549 : Yes No.r <br /> Unknown r If no, explain: <br /> � r <br /> Describe septic installation . to 'be installed: <br /> 2. bf,&JER SUPPLY <br /> Is Water supplied. by private well : Yes iso Is well proper: <br /> Yes iia 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 & REFUaK <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MOSQUITO LAR VECTOR t' <br /> State possible vector potential 8.4 necessary control: <br /> i <br /> 5 . TOILET/BATH FACT JTES <br /> No. & location existing: �� Additional <br /> facilities needed <br /> 6. PREVIORS OPERATION HISTQRX <br /> 7. GENERAL SANITATION <br /> State any problems not Previously noted: <br /> i <br /> Appx. No . People per .aq. mi. <br /> a <br />