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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 STJPgT.Y <br /> Is wat supplied by private well : Yes No_ Is well proper: <br /> Yes_ No_ State deficiency :_ <br /> Does existing or porposed use make- this well pub c water: Yes <br /> No—A---B-ample of well water taken: Yes_ No Date taken <br /> Results 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 oRV �''TO L' 'Pr,.I1TIAL, <br /> State possible vector potentiril & necessary control : Aerd i� <br /> V ✓ 4 <br /> 5 . TOILET/BATH yAcILIj,Es <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PRF.VTOU^ OPERATION HTSTORY <br /> P �n.t �. T int, �'"2 �,g <br /> 7 . GENERAL SAt3TTATTON Aj' 22 <br /> State any problems lint Prevlou61y noted : _ <br /> 9 . POP[1LATION DENSITY <br /> Appx . No . People.'per aq . mi . <br />