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I <br /> 1. SEWAGE <br /> Distance to Public Sewers-� Connection necessary: iYes _ No _ <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 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: 4e— <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POMITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6, M ILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISMRY , <br /> d. GENT AL SANITATIOII <br /> State any problems not previously noted: <br /> i <br /> 9. FOPUTATIO14 DENSITY <br /> Appx. j4o. People per sq, mi. <br />