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1 . Sr%WAGH <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 /> Describe septic installatioNt eQ�-1 alletlil �-e- <br /> 2. WATER SUPPLY <br /> Is wate supplied by private well: Yes No— Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does a sting or porposed use make this well pub 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 ick-up: Yes_ No_ Service Area No. <br /> Other proposed dispo 1 method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR Vrir!Tr)n n,,jRi1T7A , <br /> State possible vector po'11entitil & n essary control: <br /> 5. TOT , .T/BATH FAC TES <br /> No . Fc location exictina: Additional <br /> facilities needed _ <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SAiITTATION <br /> State any problems not/reviously noted: <br /> 8 . EnPU .ATTON DELISTTX <br /> Appx. No . People per sq . mi. <br />