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i . SEWAGF <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 /> flip <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY `� S <br /> Is wate supplprivate well` Ye_-4-'� No Is well proper: <br /> Ye,s-.b,Z No. State deficiency : <br /> *73- ::SLK <br /> Does existing or porposed use make this well public water: Yes <br /> No �--" Sample of well water taken: Yes No_Z,,= ITate 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 . FLYS M050UITQ OR VQ..TC) PC)ECNTIAL <br /> State WSSiVe vector pRA necessary c trol : <br /> r <br /> 5. TQTLET/BATH FACILITES � �,L��'-`'�< t•�l,� <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRFVTOf12 OPERATION HISTORY <br /> �r•� <br /> 7 . GENERAL SAPIIT,ATION <br /> State any problem; not previously noted: <br /> 8 . POPULATIO14 DE NSTIY <br /> Appx. No . People per eq . mi . <br />