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I. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic syste-mco�ply with Ord. #519: Yes No Unknown <br /> If no, explain: — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> C_ n <br /> 2. TER 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: 1�,��,, i / <br /> r ---�_..... <br /> 3. GARBAGE &, REFUSE S e�� <br /> Licensed scavenger pick-up: Yes — No Service Area No. <br /> Other proposed disposal method.- <br /> Potential <br /> ethod:Potential problem: _ <br /> 4. FLY, NyOSQUITO OR VECTOR I aIdT7AL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEIJ TIAL <br /> State possible, burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY <br /> 6. GEIZRAL SANITATION <br /> State any problems not previo� .-ly noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per so <br /> LH 06 06 3/71 <br /> 4/74 750 <br />