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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: ; Yes _ tdo _ <br /> Does existing septic system comply with Ord. #"119: Yes. No Unknown ' <br /> If no, explain: _ — <br /> Describe septic installation to be installed: <br /> Additional information or comments: 'Lnz Sr <br /> 2. W R SUPPLY <br /> Is water supplied by private well: Yes _ No Is well proper: Yes N <br /> State d f cy: <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: ::t=:::22_.4 2L <br /> 3. GARBAGE & RE1-uSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No.— <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POIENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILE,T/}3ATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> r <br /> GENTRAL SANITATIOII <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx. No. People per sq, mi. <br />