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1. SEWAGE k�� <br /> Distance to Public Sewers Connection necessary: Yes No � r <br /> Does existing septic system comply with Ord. #549: Yes No Unknown r <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 private well: Yes No _ Is well proper: Yes No <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. GARDAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No Service Are k_No. <br /> Other proposed disposal. method: ' <br /> Potential problem: <br /> 4. FLYS MOSQUITO OR VECTOR MIUMAL <br /> State possible vector potential & necessary control: <br /> i <br /> 5. AIR POLLUTION POT114TIAL <br /> State possible burning or processin, pollutants & necessary control: <br /> 6. TOILEVEATE{ FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> GENTRAL SA 41TATIO14 <br /> State any problems not p viously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. mi. <br />