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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No _ <br /> Does existing septic system comply with Ord. <br /> If no, explain: N�49: Yes _ No _ Unknown <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 <br /> State deficiency: No . <br /> Does existing or proposed use make this well:, No Date <br /> water: Yes No <br /> ublic <br /> Sample of well water taken: yeIt <br /> ate Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem; <br /> 4. FLY MOSQUITO OR VECMR POTENTIAL <br /> State possible vector potential & necessary . <br /> control. <br /> $. AIR POLLUTION POMjTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. MiLE.T/HATH FACILITIES <br /> Ho. & location existing: <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY t <br /> ------------- <br /> o. GENTRAL SANITATIO14 <br /> State any problems not previously noted: <br /> ------------- <br /> 9. FOPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />