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1 <br /> 1 . SEWAGE <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 /> Deacr.ihe--a ptic installation to 'be in <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes �iIo Is well proper: <br /> YesF-,,- No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> Noample of well Water taken: Yea Nom' ate taken <br /> Resu is 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. FLY. MOSQUITO OR VECTOR P0T2,NTTAL <br /> State possible vector potentiztl & neces§-a=-..control: <br /> 5 . TOTL�/BATH FACILITES <br /> No. & location existing: /'� Additional <br /> facilities needed <br /> 6 . pREVTonS O EgATION HISTORY <br /> 7 . GENERAL SANITATTON <br /> State any problems not previously noted: <br /> 3 . POPULATION DFLYSTTY .................. <br /> Appx. No . People per eq. mi. <br />