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• 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: + YesNo <br /> Does existing septic system comply with Ord. #519: Yes, ' No . Unknown ✓ <br /> r <br /> ,t <br /> D cr-i M C inst to , <br /> tiozz P, <br /> Additional information or comments: ,,p <br /> 2. WATER SUPPLY f�lj/ [/?" �+ <br /> Is water supplied by private well: Yes No Is well proper:' Yes L,,- No <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes No .A-� <br /> Sample of well water taken: Yes — No L,- Date Taken Results <br /> Additional information or cozmnents: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No. Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: ..W <br /> ! . FLY MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLIITION POTENTIAL <br /> State possible burning or-processing pollutants & necessary control <br /> 1001 <br /> 6. TOILET HATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISMRY , <br /> G Ira <br /> GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. mi.. <br /> e <br />