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1 . SEWAGE <br /> Distance to Public Sewers AJZA_ Connection necessary : Yes No <br /> Does existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknowns_ If no, explain:: <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: Yes <br /> No__'�_ Sample of well water taken: Yes No Y Date taken <br /> Results Additional information or comments <br /> CL)IL-! <br /> 3 . GARBA & REFUSE <br /> License scavenger pick-up: Yes No Service Area pYo . <br /> Other pro sed disposal method: <br /> Potential p oblem: - <br /> 4 . FLY MOSQUITO DR VECTORPS►'PfdTlt� <br /> State possible ector potentiftl R.c necessary ntrol : <br /> 5 . TQILET/HATH FACILITES \\ <br /> No . & location existing, : Additional <br /> facilities needed — <br /> 6 . pgEVTOt1S �P +.RATIOtd HISTQFiy <br /> 7 . GENERAL SAt4T'TATION <br /> State any pro leets not previously noted : <br /> 3 . POPULATION I Et r T v <br /> Appx. No. People per sq . mi . <br />