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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: iYes No <br /> Does existing septic system comply with Ord. #549: yes. i No - 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 wall: Yes ' <br /> State deficiency: NO -- Is well proper: Yes No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes _ No _ <br /> No _ Date TakenResults <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 MOSQUIIU OR VECIUR P0IENTIAL <br /> State possible vector potential & necessary control: • <br /> 5- AIR POLLUTION POIMJTIAL <br /> Stato possible burning or processing pollutants & necessary control: <br /> 6. TOILET/PATH FACILITIES <br /> Ivo. & location existing: <br /> 7. PREVIOUS OPERATION I,IS1 Ry Additional facilities needed <br /> d. GENERAL SANITATIO►1 <br /> State any problems not previously noted: <br /> 9. fOPULATION DENSITY <br /> APpx• No. People per sq. mi. <br />