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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #ib9: Yes No nown <br /> Unk <br /> If no, explain: _ <br /> Describe septic installation to be installed: <br /> Additionalor tion or, co ents: - <br /> 2. WATER SUPP <br /> Is water supplied by private well: Yeses r1,i'� <br /> No Is well proper: Yes No <br /> State deficiency: � '— .�. <br /> Does existing or proposed use make this wellp ublic water: Yes <br /> Sample of well water taken: Yes No D — No <br /> Date Taken Result — <br /> Additional information or comments:! G /� <br /> 3. GARBAGE & REFUSE �� s/ <br /> Licensed scavenger pick-up: Yes — No Service Area No. 7- <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUIIU OR VEC1U R P0ICNTIAL <br /> State possible vector potential & necessary control: " <br /> AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6• ?OILETf ATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION I S7uRY ' <br /> �. GENERAL SANITATIOII <br /> State any problems not previously noted: � <br /> ;e—, O l lc +? 01. <br /> 7 J <br /> T� o 11i��»„ c 7p .J sf <br /> 9. FOPUTATIO14 DENSITY <br /> APpx• No, People per sq, mi. <br />