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1 . MAUI <br /> Distance to Public Sewers 01Connection necessary: Yes No� <br /> Does existing septic system comply with Ord. #549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe peptic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Iles V No Is well proper: <br /> Yes No State deficiency : _-- <br /> Does existing or porposed use make this well public water: Yes <br /> No I 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 . ZM_ MOSQUITO OR Y =,-_MQ 'MTUU1AL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET,/BATH FACILI7ES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATIO14 JSTQRY <br /> 7 . GENERAL SANIThMM. <br /> State any problems not previously noted: <br /> 8 . POPULATIQU DE .ITY ' <br /> Appx . No . People per sq . mi .- <br />