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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 /> C� � i st ✓lr q ✓ ,� ,lhd/e <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: 'les <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RB US . <br /> Licensed scavenger pick-up: Yes No— Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR VR„^TOR PO'rr,14TIAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILF.T/BATH FACILITES <br /> No. Fc location existing: Additional <br /> facilities needed <br /> 6 . PREVTOUS C)PERATToN HTsTnRY / <br /> .�' Srf�j vyf rli � <br /> 7 . GENERAL SANITATTON <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTTY <br /> Appx. No . People per eq. mi. eeS/tJe..�a� <br />