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1. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: Yea _ No ✓ <br /> Does existing septic system c mply with Ord. /549: ,Yes ✓ No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _Zko _ Is well proper: Yes t,-�No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _ No <br /> Sample of well water taken: Yes No _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE &, REbU SE / <br /> Licensed scavenger pick-up: Yes tz No _ Service Area No. C, <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR F:,:7 TIAL <br /> State possible vector potential & necessary control: �.L.�.L�lf <br /> c � l_r� f / a✓l� c a Pel ✓ r w, S <br /> 5. AIR POLLUTION POTENTIAL <br /> State p//oss'ble b ning or processing pollutants & necessary control: <br /> /k � /J/' �. �1�arery �U ✓'ikstru- � <br /> 6. TOILET BATH FACILITIES �— <br /> No. & location existing: /,./Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> / r s 1)lzlw� ")m /29`Ca'' S <br /> 8. GENERAL SANITATION <br /> State any problems not previo sly noted: 1 <br /> i�rrs — �y'ar Fuc/( ..� - - e r <br /> .1 Q7V /� <br /> T <br /> 9. POPULATION DENSITY / / <br /> A px. No. People er sq 9f iYaA ��i'� h_f 411 <br /> SH 06 06 3/71 4/74 750 <br />