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SEWAGE <br /> Distance to 'Public Sonarsr <br /> I DOZE Connection necessary. i Yes No � <br /> Docs existing septic system com 1y'with Ord. 1549: Yes. ' No Unkno n ✓. ., <br /> If no, explain: ' <br /> Describe septic installation to be installed: <br /> Additional information or comments: C r• wt �.o ok, <br /> c Hrtoc cam <br /> 1C ulfr cr� re ,. . <br /> 2. WATER SUPPLY <br /> .Is water supplied by private woll: Yes +/' No Is v6ll properi Yes �(o <br /> State deficiency: ---• �- <br /> Does existing or proposed use make this wall, public water: Yes No <br /> Sample of well water taken: Yes NO Data Taken rl <br /> —. ._. 8 S Results cCleA <br /> Additional information or comments: Well w4 ,m <br /> 3. GARIIAGE & REFtlSE <br /> Licensed scavenger pick-up: Yes No .__._ Service Area No. <br /> Other proposed disposal method: ' <br /> Potential problem: <br /> Lt. FLY MU5QUIM 011 VECMR POTENTIAL <br /> State possible vector potential & necessary control: <br /> �. AIR POLI.UTTON POMITIAL <br /> State possible burning or-processing pollutants &necessary control: <br /> 6. miLET AATH FACILIT <br /> No. & location existing: Additional facilities needed <br /> •7. PREVIous' opkRATION 1{IS'3p1MY <br /> 8. GEVERAI, SANITATI011 _ <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />