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Distance to Public Sewers Connection necessary : Yes— No_ <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 Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . El, MOSQUITO OR V ^TCS PCE�IiTIfi:� <br /> State possible vector potential Az necessary control : <br /> 5 . ZOILFT/BATH FArILI <br /> No . & location, existing : _ Additional <br /> facilities needed —_ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SAiITTA'PION <br /> State any problems riot previously noted : — <br /> a . <br /> oted : _9 , p0 U ,ATION DENSTTVY <br /> Appx. No. People per sq. mi . <br />