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t � <br /> 1 . SCIAGE <br /> Distance to PublicSewers - Connection necessary: Yes No <br /> Does existing septic system comply with Ord. 31549 : Yes No_ <br /> Unknown If no, explain: <br /> Deser aept c Installation to 'be installed:,��Z-' <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Na Is well r r: <br /> Yes No State, deficiency: <br /> Does existing or porposed use make- thia well public water: Yes <br /> No Sample of well water taken: Yes No Late tgken._.w� <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 . <br /> roblem:4 . FLY-L MOSQUITO OR V ^T0EL rM11 , <br /> State- possible vector potentiftl ?.c necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PRFVIOnS OPERATION <br /> 7 . GENERAL SA1U A`l' -(-) <br /> State any problem: not previously noted: - <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per rq . <br />