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1. SEWAGE ��- <br /> Distance to Public Sewers ,:, . Connection necessary: ; YesNo <br /> _ <br /> Does existing septic system comply with Ord. #'>49: Yes. No Unknown <br /> If no, explain: — — — <br /> Describe septic installation to be installed: <br /> Additional information or coiiuuents: <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 /> 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 /> • <br /> 5• AIR POLLUTION POTENTIAL — <br /> State possible burning or processing pollutants & necessary control: <br /> 6. MILET BATH FACILITIES <br /> No. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISMRY . <br /> • GENERAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx, No. People per sq, mi. �i��9,��i��Ci�•d��`�,�� G 'i'd <br />