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1 . S.EWASaF� <br /> Connection necessary : Yes_ No_ <br /> Distance to Public Sewers <br /> Does existing septic system comply with Ord. 41549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . EATER 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 tarsen: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & w . US <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . FILY� MOSQUITO OR VEt"TO EC)rL TIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOTLET/BATH FAQ UITES <br /> No . & location existing: _ Additional <br /> facilities needed- <br /> 6 . <br /> eeded6 . PREVIOUS OPERATION Hlf,-T=, <br /> 7 . GENERAL SANTT TION <br /> State any problems not previously noted : _ <br /> 9 . pOPULATTON PE?d,i TY <br /> Appx. No . People per sq. mi . <br />