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1 . SEWAGE <br /> Distance to Public Sewers !A Connection necessary : Yes No. <br /> Does existing septic system ' comply with Ord . 31549 : 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 Pu lic water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE €a REFUSE ! ' <br /> Licensed scavehaer pick-up: Yes No Service Area No . <br /> Other proposed disposal method: / <br /> Potential problem:. <br /> 4 . MY-1- MOSQUITO OR V 2,1(,- P2T.EULT.AL <br /> State possible vector, potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVToPS OpEgATIotj HISTngX <br /> 7 . GENERAL SA1U jC). <br /> State any problems not previously noted : <br /> 3 . pn P ILATION DE NSTIv <br /> Appx . No . People per rci . mi . <br />