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1 . SEWAGE <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 /> Des ribe a ptic nortallation to be installed: ����d� <br /> 2 . WATER SUPPL`I <br /> Is water supplied by private well : Yes _ Nom 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 Datq taken <br /> Result/s Additional information or <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOSQUITO OR -YECTOR—VECTORZCjrXNjjA,,iT <br /> State possible vector potentiftl & necessary control : <br /> 5 . TQI ET/BATH FACTLTTES <br /> No . & location existing: _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTQRY <br /> 7 . GENERAL SAJITT '1A ION <br /> State any problems riot previously rioted : _1 �F <br /> 9 . POPULATION DENSTTY <br /> Appx . No . People per sq . mi . ��•1i��/`�lf —.c��✓i✓f��.rr� <br />