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� . SEWAGE <br /> Distance to Public Sewers L7oc Connection necessary: Yes ZNo_ <br /> Does existing septic system comply with Ord . 11549 : 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 Na ✓Is well proper: <br /> Yes No State deficiency: <br /> /V d a��,4t o�*/ /,(' (' �< �P 1`s-le' <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> w <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal meth d: <br /> Potential problem: <br /> 4 . FAL MOSQUITO QR EQTQR POrELJT <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIOPE OPERATION HISTO£;Y <br /> 7 . GENERAL SAPL1T '1.A 'I0N <br /> State any problems not previously noted:- <br /> 3 . <br /> oted:_3 . POPULATION DENSITY <br /> I v <br /> Appx. No . People per rq. mi . <br />