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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ Nom <br /> Does existing septic system comply with Ord. 11549 : Yeses No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: -14&�F <br /> 2 . WATER SUPPLY <br /> Is wh er supplied by private well: Yes No_ Is well proper: <br /> Yee No_ State deficiency: •'✓�� <br /> Does existing or porposed use make tlxis well public water: Yes <br /> No Sample of well water taken: Yes_ No-;�L Date to en <br /> Results Additional information or comments f <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses, No_, Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSQUITO OR V�^.T=riR 1'0'f1 NT?At' <br /> State possible vector potential & necessary control: �f _ <br /> 5 . TQI L •T/BATH FACILITES 1 <br /> No . & location existing: 92�e- Additional <br /> facilities needed _ <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DEMSTTY <br /> APpx. No . People per act. mi. <br />