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1. SEWAGE <br /> Distance to Public Sewers / = Connection necessary: ; Yes _ 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: <br /> 3. GARBAGE & REFUSE / <br /> Licensed scavenger pick-up: Yes .4 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 /> A <br /> 5. LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: ofd -tef Additional facilities needed ,V�) <br /> 7. PREVIOUS OPERATION HISTORY ; 1 <br /> GENTMAL SANITATIOII <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. �o.r/ �c��✓j-.'= �l�f/Dc�sy �i•,° % is�r f�la�� ��t <br />