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o <br /> 1. SEWAGE <<� <br /> Distance to Public Sewers Connection necessary: ; Yes _ 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 /> Additional information or comments: <br /> .��-_�.. •�'- <. 1�..�./' / G ! _- c-� v' Com' � �-- Cr y /,'�." �� E'3�e� ,a r'�` <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No _ Is well proper: Yes _ No <br /> Does existing or proposed use make this well public watery Yes No _ L,. <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 /> LTJ <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. M ILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . y5 <br /> ir°_r: / mac'/._.._r'�`r �" , � /.�9=�• �.�_-d <br /> 8. GENERAL SANITATIOIJ <br /> State any problems not previously noted: �--- <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />