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1. SEWAGE <br /> Distance to Public Sewers ° <br /> Does existingseptic <br /> Connection necessary: iYes No <br /> P system comply with Ord. N-49: Yes• I No ° <br /> Il no, explain: Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: /10� <br /> ����i91� rE1�.�'F.-1'�� � ✓,ski �� . ,� �"rF .,l./,�F�.�,�'�.�_ �. N.• <br /> 2. WATER SUPPLY <br /> Is Water supplied by privato uoll: Yes ..,•. <br /> �.. NO Is well proper:. Yes <br /> State deficiency: No <br /> Does existing or proposed use raake this well public water: Yes <br /> Sample of well water taken: Yes No No <br /> � Date Taken Results '• <br /> Additional information or comments: /f <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No ` Service Arca No. <br /> Other proposed disposal method: <br /> Potential problem; , <br /> 4. FLY. MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> S. AIR POLLUTION POTEIJTTAL <br /> State possible burning or processing pollutants &necessary control: '- <br /> 6. miu,;TJBATI{ FACILITIES <br /> NO- & location existing: �: <br /> ?• PREVIOUS OPERATION HISTORY Additional facilities needed <br /> d. GEU AL SANITATI011 <br /> State arty problems not previously noted: <br /> 9• POPUTATI014 DENSITY <br /> Appx. 14o. People per sq. mi. <br /> • <br />