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i . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_. <br /> Does existing septic system comply with Ord . 31549 : Yes No_ <br /> Unknown 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 Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFQSR <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY . MOSQUITO OR VE TOR PO'CENTIAL <br /> State possibly: vector potentifdl & necessary control: <br /> 5 . TOIL .TiBATH FAC, ITE <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PRRVICnS OPERATION HISTORY <br /> 7 . GENERAL SANTIATT N <br /> State any problems not previously noted : <br /> 8 . POP[I .ATT0t4 DEN STT`.' <br /> Appx. No . People per eq. mi . <br />