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`2) A <br /> 1. SEWAGE r <br /> Distance to Public Sewers d''OiConnection necessary: Yes No <br /> Does existing septic system comply with Ord. 4549: Yes _ No _ Unknown — <br /> If no, ezpha�n:� <br /> Describe septic installation to be installed: l,✓5� a <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> I =titaite2 `supplied-,by private well: Yeses 140 Is well proper: Yes No <br /> Stte 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 do REFUSE <br /> Licensed scavenger pick-up: Yes ,i No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> l�. -FLY;' MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POMITIAL h <br /> State possible burning or processing pollutants & necessary control: /V <br /> 6.; TOILET/SAni FACILITIES . <br /> No. do -location existing: Additional facilities needed <br /> 7. i ffEVIOU5 01,EhATION HISTORY <br /> 8. GF-14M AL SANITATION ,A,J <br /> State any problems not previously noted: AoY C- <br /> 9 POPULATION DENSITY <br /> Appx., No. People per sq. mi. V�� CU f� <br />