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1. SEWAGE <br /> Distance to Public Sewers / ` <br /> Does existin septic Connection necessary: ' Yes — No <br /> G p system comply with Ord. A-U9: Yes. _ No Unknown . . <br /> If no, explain: <br /> Describe septic installation � <br /> to be installed:: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes ..... <br /> State- deficiency: NO Is well proper: Yes No <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. GARBAGE & REFUSE --__-- <br /> Licensed scavenger. pick-up: Yes No <br /> Service Area No. <br /> Other proposed disposal method; <br /> Potential problem: <br /> 4. FLY I MOSQUITO OR VECMR POTENTIAL <br /> State possible vector potential & necessary - <br /> . tcontrol. <br /> S. AIR POLLUTION POMjTIAL <br /> State possible burning or processi <br /> ngpollutants & necessary control: <br /> 6. mILET MTI{ FACILITIES <br /> No. & locution existing: <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION 1{ISMRY <br /> o. GEI4TRAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. FOFULATION DENSITY <br /> Appx. "40. People per sq. mi. <br />