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1 . 5EWAGE 1 <br /> Distance to Public Sewers Connection necessary: Yes Nox— <br /> Does existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknown. If no, explain : <br /> c <br /> Describe septic �nstallation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ✓No Is well proper: <br /> Yes. y No State deficiency : <br /> Does� i <br /> xsting or porposed use make this well pubes water: Yes— <br /> No— <br /> esNo Sample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE &- REFUSE <br /> Licensed i9avenger pick-up: Yes No Service Area No . <br /> Other propo'aed disposal method: <br /> Potential problem: <br /> 4 . MOSQUITO 0$ ROTOR ECi'frM <br /> State possible vedtor potentiftl & ecessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATIO14 HISTO r <br /> 7 . GENERAL SAi O <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DE t DTTY <br /> Appx . No . People per eq . mi . <br />