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1 . SEWAGE <br /> Distance to Public Sewers , l' Connection necessary: Yes Nom <br /> Does existing septic system ' comply with Ord. 31549 : Y4= 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 � coo Is well proper: <br /> Yes I No State deficiency: <br /> Does existing or porposed use make this well public water: Y sem' <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. FLY. MOSQUITO OR VFQ.TQR P.0'I72, TTA , <br /> State possible vector potential necessary control: ! <br /> 5 . TQTLET/BATH FACILijTFB s Additional <br /> No. & location existing: <br /> facilities needed <br /> 6. PREVT001; OPERATION HISTORY <br /> i <br /> 7. GENERAL SANT_ T ON � <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No . People per sq. mi. <br />