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1. SEWAGE < <br /> Distance to Public Sewers Connection necessary: Yes X No _ <br /> Does existing septic system comply with Ord. #519: Yo s. No Unknown <br /> I£ no, explain: _ — — <br /> Describe septic installation to be installed: <br /> k, A- . <br /> Additional information or commenti: <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:LA <br /> 3. GARGE & REFUSE <br /> DAe we!G c C o vie.e- <br /> Licens6d scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal meth <br /> Potential problem: <br /> l;. FLY, MOSQUITO OR VECTOR POTUIT'IAL <br /> State possible vector potential & n cessary control: <br /> 1 <br /> 5. AIR PO LLU TION POTE14TIAL <br /> State possible burning or 'processing (pollutants & necessary control: <br /> 6. ToiLET BATH FACILITIES <br /> No. & location existing Additional £acilit es needed <br /> 7. PREVIOU� OPERATION HIS RY . <br /> cs. GENTRAL�SANITATIOII 1 <br /> State a . problems of previously noted <br /> 9. POPULATION DENP. TY <br /> Appx. No. ople per sq. mi. <br />