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1. SEWAGE <br /> Distance to Public Sewers r <br /> Connection necessary: iYes No f <br /> Does existing septic system comply with Ord. #'49: yes. I _ <br /> If no, explain: No Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY w <br /> Is water supplied by private well: Yes .•-•• <br /> NO — Is ��- Proper: Yes <br /> State deficiency: No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes 110 No <br /> Date Taken Results <br /> Additional information or comments: ------ --- <br /> 3. GARDAGE & REFUSE <br /> Licensed scavenger. pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> FLY MOSQUITO OR VECTOR LMTIAL <br /> State possible vector potential & necess --- <br /> o ary control. <br /> 5• AIR PO LLU TION POTENTIAL <br /> State possible burning or processing pollutant., & necessary control: <br /> 6. 10ILET/L�ATIi FACILITIES <br /> tvo. & locution existing: ' <br /> 7. PREVIOUS OPERATION HISTORY , Additional facilities needed <br /> d. GEVERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. 14o. People per sq. mi. <br />