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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 /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water,- supplied by private well : Yeses No Is well proper: <br /> Yeso State deficiency : <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 /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . =,- MOSQUITO 0$ VZ^T( ZC)E N, TIAL <br /> State possible vector potentiftl Fz necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing : Additional <br /> facilities needed _ <br /> 6. fl^ OPERATION HISTQR <br /> 7 . GENERAL SAPTT'r TION_ <br /> State any problems not previously noted : - <br /> 8 . <br /> oted :8 . POPULATION DENSITY <br /> TTY <br /> Appx. No . People per rq . mi . <br />