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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No X <br /> Does existing septic system 6oifioly with Ord. 4549: Yes _ No _ Unknown <br /> If no, .explain:____. <br /> Describe septic installation to be installed: <br /> Additional information or comments:: <br /> 2. WATER SUPPLY <br /> !q-r-tatet supplied by private well: Yes �6 EJo Is well proper: Yes t-Io- <br /> Strts deficiericy:': <br /> �•.. .. r <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: rn�-- <br /> 3. GARBAGE & RMSE <br /> Licensed scavenger pick-up: Yes No _ Service Area No. <br /> Other proposed disposal method: <br /> Fotential problem: ` <br /> 4. FLY,' MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTIOLN POMITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. ; TOILET/BATH FACILITIES_ �" <br /> No. ,& location ' G'/existing: - Additional facilities needed <br /> 7. ?ftGVIOUS OVEhATION HISTORY <br /> 8. GENERAL SANITATION <br /> State any problems not previously noted: IZICT '`• <br /> 9. POPUI:ATION DENSITY . <br /> A No People s . mi. <br /> rrX . re �er 1 <br />