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l�) <br /> 1. SEWAGE �\�� <br /> Distance to Public Sewers lConnection necessary: Yes _ Noe ' <br /> Does existing septic system comply with Ord. #549: Yes. _ No _ Unknown <br /> If no, explain: <br /> tic insta <br /> Additional information or comments S_ <br /> 2. WA SUPPLY e h011 7 r'� LFit_ /G-oti �' o - ✓✓��c,,� .�F�i. <br /> Is water supplied by private well: Yes No Is well proper: Yes _ No r� <br /> State deficiency: 70 <br /> Does existing or propo ed use make this well public water: Yes No ✓ <br /> Sample of well water taken: Yes _ No ­XDate Taken Results <br /> Additional information or comments: -b L5 441 -1 <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes — No Service Area No. =----- <br /> Other proposed disposal method: <br /> Potential problem: <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: <br /> 6. TOILEWBATH FACILITIES <br /> No. & .location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTO <br /> ci <br /> �. GENERAL SANITATIO14 <br /> State any problems not previously rioted: 6? _. <br /> 9. FOPU <br /> Appx. No. People ee�7fi"i: <br />