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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 11549 : Yes No._ <br /> Unknown If no, exi?lain: <br /> LO <br /> Describe septic installat on to *be installed: <br /> /moi /G <br /> 2 . WATER SUPPLY �.Q�- Z <br /> Is wat supplied by private well : Yes lff'lo Is well proper: <br /> Yes No State deficiency: <br /> Does ex ng or porposed use make this well public water: Yes <br /> No Sample of well water taken : Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yom-- - No Service Area No. <br /> Other proposed disposal meiottd: <br /> Potential problem : <br /> 4 . FLYS MOSQUITO OR Y C) EC)r ZNTIAL <br /> State possible vector pgntiftl & necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVTOO& OPERATION HIST' - <br /> "-0� <br /> 7 . QENERAL SAIJIT '1� 'ION <br /> State any problems not previously noted: _ <br /> 8 . pOPULATIOtd DFNSTIX <br /> Appx . No . People per oq. mi . <br /> Al U <br />