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1. SEWAGE <br /> Distance to Public Sewers <br /> �' Connection necessary: iYes No <br /> Does existing septic system comply with Ord. N'49: Yes• ; ' No _ Unknown <br /> If no, explain: �'_ . . <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2- WATEn SUPPLY w <br /> Is water supplied by private well: Yes No <br /> State deficiency: Is well proper: Yes No f <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes ?lo No <br /> — .__. 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: <f ti✓ � <br /> 4. FLY, MOSwil'U OR VECTOR POTCNTIAL <br /> State possible vector potential & necessary control: y�f <br /> S- AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: - <br /> 6• mILET/BATH FACILITIES <br /> No. & location existing: <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION 1{ISTORY , , <br /> «'moi <br /> q. GE1,ERAL SANITATION <br /> State any problems not previouzly noted: <br /> 9. FOPULATION DENSITY <br /> Appx. j4o. People per sq. mi. <br />