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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord , 11549 : 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 & RFFQSF <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELY MOSQUITO OF V E^TO EL)fj2LT A,1L <br /> State- possible vector potentirtl & necessary control : <br /> 5 . TOTLFT/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed __- <br /> 6 . PRFVTOf75 QPERATT-0E HIST�PX <br /> 7 . GENERAL SAPJITATION <br /> State any problems not previously noted : - <br /> 8 . <br /> oted : _9 . pOP[ILATI 14 DENST_TI <br /> Appx . No . People per sq. mi. <br />