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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: lyes — No - s <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 /> 2. WATER SUPPLY <br /> Is water supplied by privato well: Yes No Is well proper: Yes No A <br /> State deficiency: <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 /> Licensed scavenger pick-up: Yes �. No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> L�. FLY, MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POIMITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILEVEATH FACILITIES <br /> No. & location existing: ��;-��F ,//,2 f Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY . <br /> 8. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx, ido. 11'eople per sq. mi. <br />