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1 . SEWAGE r r <br /> Distance to Public Sewers '' Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 41549 : 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 /> Na Sample of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal <br /> Potential problem: <br /> problem: <br /> 4 . =L MOScrUITO OR V ^TO ,'rrc,HI�L <br /> State- possible vector potentif,l & necessary control : <br /> 5 . Thi -FT/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOnS CTERATIONT i <br /> f <br /> JP <br /> 7 . GENERAL SANITATION <br /> State any problems not previously notad : <br /> 3 . F-E ILATIO14 Dr NSTI <br /> Appx . No . People per rq. mi . <br />