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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord . 41549 : Yes No <br /> Unknown If no, explain: <br /> .. R <br /> Describe septic installation to 'be netalled. <br /> 2 . HATER SUPPLY <br /> Is water supplied. by private well : Yes No Is well proper: <br /> Yes . No State deficiency: <br /> A)n <br /> Does existing or porposed use matt• this well pubic water: Yes <br /> No — Sample of well water taken: Yes No V' Date taken <br /> Results Additional information or comments <br /> 7 ,: <br /> 3 . GARB6GE & REFUSE <br /> Licensed scaven er pick-up: Yes No Servi a Area No. <br /> Other proposed i osal method: <br /> Potential problem: <br /> 4. U1. MOSQU,.ZTQ n.R V E^TC? YE 1NTTAL <br /> State possible vector tential n -.essary control: <br /> 5 . TOILET/BATH FACYLITE5 Y i <br /> No. ek location existing: A Additional <br /> facilities needed <br /> 7 . rABNERAT, Ir O N <br /> State any pr 'blems not Previously noted-_\- <br /> 8 . <br /> oted:8 . Q J T Ea r1_Tren <br /> Appx. No. People per sq. mi . <br />