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1 . SEWAGE , <br /> Distance to Public Sewers l`` Connection necessary : Yes No_ <br /> Does existing septic system comply with Ord . 4549 : Yes No, <br /> If no, explain: <br /> Describe septic installation to 'be insta//llec.: sf • �'�r: i <br /> 2 . WATER SUP L I %o.6 l <br /> Is water supplied by private well : es o Is well proper: <br /> Yeses No Start -de_� lcncy : , <br /> Does ex fng or porposed use ""make tll.is well public Water: Yes <br /> No Sample of well water tarsen: 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 . =� MOSQUITO OR V ^.TO E2f=AL <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : - Additional <br /> facilities needed <br /> 6 . PREVIOnS QPERATION HISTORY <br /> -/r <br /> 7 . GENERAL SA U '1,A ' -C-) <br /> State any problems not previously noted : <br /> 3 . pOPULATIOP4 DEN `ll <br /> Appx . No . People per sq. m i . �,,� <br />