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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: ; Yes No LC <br /> Does existing septic system comply with Ord. #5h9: Yes _ No _ Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> L �L L o <� Lr �a J(" <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well- <br /> Yes No _ Is well proper: Yes _ No <br /> � <br /> State deficiency: � <br /> Does existing or proposed use make this well public water: Yes _ No <br /> Sample of well water taken: Yes _ No Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavengerck-up: Yes _ No Service Area No. <br /> Other proposed disposl method: <br /> Potential problem: <br /> 4. FLY MOSQUITO OR VECTOR 7S7lTL4L / <br /> State possible vector poten 'al & necessary control <br /> $. AIR POLLUTION POTE34TIAL <br /> State possible burning or processingp�I tants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: ; Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> x <br /> i <br /> b. GENERAL SANITATIO14 <br /> i <br /> State any problems not previously noted: <br /> L <br /> 9. FOPUTATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />