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1 . RSWA S <br /> Distance to Public Sewers Connection necessary : Yes— No— <br /> Does <br /> oLDoes existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe se tic installation tQ be installed: �Ga' ��k <br /> 3'-2�P/�S /W TN,SNQFR7 <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: 'les <br /> No L 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 . FLY. MOSQUITO OR VRCTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILFT/BATH FACILTTES <br /> SFS Ue+l/C�E Additional <br /> No . & location existing: <br /> facilities needed <br /> 6. PREVIOUS OPRRATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: 41/LCL& <br /> 3 . POPUE,ATTQM DENSTTY <br /> Appx. No . People per eq. mi . � .- <br />