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�) <br /> 1. SEWAGE � vo� h r. ��o y� ��r �T� l�1 <br /> Distance to Public Sewers Connection necessary: iYes _�No _ <br /> Does existing septic system comply with Ord. #549• Yes. No Unknown <br /> If no, explain: — — — <br /> Describe septic installation to be installed: <br /> Add'tional information or comments: <br /> I , f = <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 Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Po-teu4izt--problem: = g-- -2 -, r-y�.0 l�--t irs-�►� <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: ,-7 <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY . <br /> �Zz4/ <br /> 8. GENT AL SANITATIOIJ <br /> State any problems not previously noted: 002791 <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq, mi. --� <br /> -r-x� e dw <br />