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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 11549 : 'les_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY / G LA--j <br /> Is water supplied by private well : 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 & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : / <br /> 4 . E LYY_ M1OS(_7)UITO OR _VECTOR ECi'rj:, <br /> State possible vectors £�otentirtl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PRF.VIOr1S OPERATION HISTORY <br /> -4, i7ox <br /> 7 . GENERAL SA2JITATION <br /> State any problems not previous y noted : _ <br /> s . pOPU ATION DENSITY <br /> Appx. No . People per sq. mi . <br />