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1. SEWAGE <br /> Distance to Public Sewers <br /> Does existingseptic "—�-- Connection necessary: Yes No <br /> P system comply with Ord. #'49: yes. I <br /> Il no, explain: No Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is Water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: , <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes No <br /> No Date Taken Results <br /> Additional information or comments: <br /> 3• GARAGE & REFUSE <br /> Licensed scavenger, pick-up: Yes No <br /> Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MOSQUIM OR VECMR POTMTIAL <br /> State possible vector potential & necessary control: <br /> 5• AIR PO LTU TION P02EIJTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. MILET DATE{ FACILITIES <br /> tvo. & location existing: ,,�� ' <br /> 7. PREVIOUS OPERATION I(ISMRy Additional facilities needed <br /> d. GENERAL SANITATI011 <br /> State any problems not previously noted: �. <br /> 9. FOPULATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />