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lel <br /> 1. SEWAGE <br /> Distance to Public Sewers �' _.o Connection necessary: Yes _ No , <br /> Does existing septic system comply with Ord. #549: Yes ✓ No _ Unknown _ J1 . ' <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY ec) r j <br /> Is water supplied by private well: Yes _ No _ Is well proper: YesL/'' No _ <br /> "a4e-4e nc �► D �,� P <br /> k1 <br /> ie- oes existing o proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes — No . c=''Date Taken Results r <br /> Additional infor ation or coftents: 7a, Ye--�j .2- ��S 0 / a s p, <br /> 3• �'1bzv� 1;rh%�ti W�'/� hz� �� 6X <br /> L'ce - es _ No Servia"rea No. <br /> Other_propased ~ <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State ossible vector potential & necessary control: <br /> 2 <br /> r <br /> 5. AIR POLLUTIO POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> GENTERAL SANITATION <br /> State any problems not previously n ed: <br /> 9. POPULATION DENSITY " <br /> Appx. No. People per sq. mi. <br />