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1 . 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 /> Desc be epi insta:.lation to be installed:,r�,� <br /> 2 . WATER SUPPLY <br /> Is wa er 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 /> Nom Sample of well water taken: Yes No_,'�-" Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR V E^T0) ELi'j' EjjAL <br /> State possible vector potentiftl necessary control : <br /> 5 . T0TLET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problem: not previously noted : �o10VK <br /> 8 . POPULATION DEN3STTY <br /> Appx . No . People per eq . m i . <br />