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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: YesNo _ <br /> Does existing; septic system comply with Ord. #'49: Yes No -7- 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 No Is well proper: Yes _ 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 X" Date Taken Results <br /> Additionaj_4n.formation r comments: �ifl., %.r`U�Fa X3//0, v Er1 •y . 't �� . -1�p�� <br /> 3. GARBAGE & REFUSE" F <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO MITIAL <br /> State possible burning or processing pollutants & necessary control: ~ <br /> 6. 1UILET/BATH FACILITIES <br /> No. & location existing: s��foTa�..r.. +�c-�� E Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> o. GENERAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx, No. People per sq. mi. 1 `�.t'"%JR,�• ' ,/'ter' ,r;�"`r,,,�o►� <br />