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Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. 11549 : Yes 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 iso Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> If <br /> / v oS<z� <br /> 3 . GARBAGE & R FUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. M0S©UITO OR VECTOR PO'rENT A <br /> State possible vector potentiztl & necessary control: <br /> 5 . TOTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTQQS CERRATION HISTORY <br /> 2 <br /> 7. GENERAL SANTTATTON <br /> State any problems not Previously noted: --- <br /> 3 . POPULATTON D ,NSTTY <br /> Appx. No. People per eq. mi. <br />