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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes _ No "*1 .� <br /> Does existing septic system comply 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 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 -�L Date Taken _ Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scave er. pick-up: Yes _ No Service Area No. <br /> Other proposed d posal method: <br /> Potential problem: <br /> 4. FLY MOSQUITO OR VEC POTENTIAL <br /> State possible vector Po <br /> ntial & necessary centro . <br /> 5• AIR POLLUTION POTENTIAL <br /> State possible burning or processi lutants & necessary control: <br /> 6. TOILET/HATH FACILITIES <br /> No. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY . <br /> 6. GENTRAL SANITATIOIJ <br /> State any problems of previously noted: <br /> 9. POPULATION NSITY <br /> Appx. No. eople per sq. mi. <br />