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f <br /> 1. SEWAGE ( 2) <br /> Distance to Public Sewers Connection necessary: Yes _ No s <br /> Does existing septic system comply with Ord. #519: Yes No Unknown <br /> If no, explain: — — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> ,i <br /> __--1 cr r <br /> 2. WATER SUPPLY '' a4Cc <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: Ole <br /> '. , <br /> 3. GARBAGE & REFUSE •;. . r�'r ; . <br /> Licensed scavenger pick-up: Yes _ No Service, Area No.' e <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 POLLUTION POTENTIAL <br /> State possible burning or processings pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> Vii. GENERAL SANITATION <br /> State any-problems not prev''ously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq, mi. <br /> t <br /> J <br /> i <br />