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1 . SEWAGF <br /> Distance to Public Sewers ' 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 /> Ar <br /> 2 . NATER SUPPLY <br /> Is water supplied by pr?vnte well : `Yes ' I/"No Is well proper: <br /> Yes�tso State deficiency : <br /> Does exis -ing or porposed use make- this well public water: Yes <br /> No ample of well water taken: Yes No Date taken <br /> Results Additional informat on or comments <br /> 3 . GARBAGE &i REFUSR <br /> Licensed scavenger pi,-,k-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . F.Ly , MOSQUITO QB CQ.TQ11 _PQf.IJI�ZI <br /> State possible vector potentiftl ez necessary control <br /> 5 . TAIL .T/BATH FACILITES <br /> No . & location existing: — Additional <br /> facilities rie,eded <br /> 6 . PREV_I011S OPERATION HISTML <br /> 7 . GENERAL SANITATION <br /> State any problems dot previously noted . <br /> 8 . FCS t)LATIO14 DENST11 <br /> Apex- No . People per Bq - mi . ----- - <br /> moi, ✓ t � Ste✓ '�� <br /> .001P 7 <br /> /� s <br />