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(2) , <br /> 1. SEWAGE <br /> Distance to Public Sewers �� Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No L, nknown 1i <br /> If no, explain: <br /> r 1 <br /> G r G 7\ C/l. 1 /n z:3 •.�' � 7 ; d P 1/L-.:�d- c>> <br /> --T <br /> Describe septic installation to be installed: <br /> rl_1 U 'S; lir LJ e' <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. GARBAGE & REFUSE <br /> i <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES r-e i f«0-\_ > ,,//>r •'_j 41 r <br /> No. & location existing: �i ck� f�.nth Additional facilities needed �Y <br /> 7. PREVIOUS OPERATION HISTORY <br /> V C l f C/i 4 <br /> 6. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. �� <br />