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f <br /> 1. SEWAGE (2) <br /> Distance to Public Sewers 110 /' nnection necessary: Yes V0 _ <br /> Does existing septic system compl with Ord. #549: Yes 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 well: Yes — No,2L Is well proper: Yes _ No _ <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: fli <br /> - (h I a-j=.7 , <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes ��� Service Area No. „�!J(10 <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 7. PREVIOUS OP/E,RATION HISTORY <br /> L1711 <br /> d. GENERAL SANITATION <br /> State any- problems not previously noted: <br /> I <br /> I <br /> I <br /> i <br /> 9. POPULATION DENSITY _ <br /> Appx. No. People per sq. mi, <br /> 'i <br />