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1. SEWAGE <br /> Distance to Public Sewers /f� 'y!,�f Connection necessary: ; Yes _ No a / / <br /> Does existing septic system comply with Ord. 1/549: Yes. No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: �, ,477 <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private we Yes -T No Is well proper: Yes _ No _ <br /> State deficiency: / r OL <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 /> i <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> lt. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: �/1"l'' �" <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/PATH FACILITIES <br /> No. & location existing: !!�=1jy� r � Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> c�. GMERAL SANITATION <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />