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1. SEWAGE. (2) <br /> Distance to Public Sewers ( Connection necessary: _Yes No ' <br /> Does existing septic system comply with Ord. 4549: Yes No Unknown <br /> if <br /> Describe septic installation to be installed: � Syc� <br /> r <br /> Add itional•-information or comments: <br /> 2. WATER SUPPLY <br /> Iq-'Vater'• supplied by private well: Yes Ho Is well proper: Yes No <br /> S.t$te deficiency: ' --r- <br /> Does existing or proposed use make this well,public water: Yes Not <br /> Sample of well water taken: Yes No 4— Date Taken Results <br /> Additional information or comments: Q <br /> ,,... . c <br /> 3. GARBAGE & RASE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY,' MOSQUITO OR VECTOR FOTENTIAL <br /> State possible vector potential & necessary control: Mme• ,.�„' <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6.,. MIIET/BATH FACILITIES . <br /> No. & location existing: LnYAdditional facilities needed <br /> ?. ?MVIOUS O1'LhATION HISTORY <br /> rv_�*_1_— <br /> 8. GE14ERA1 SANITATION <br /> State any problems not previously noicd: <br /> 9. 'POPULATION DENSITY <br /> Appx. No. People per sq. mi :QCT : r <br />