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* : I. ` SEWAGE <br /> Distance to Public Sewers y tAr Connection necessary: ; Yes �i No <br /> Does existing septic system comply with Ord. #549: Yes , No _ Unk'nown <br /> If no, explain: Oc.cMm c(a1615 -i( ar.( 4L') 4»�s c'�;.1,, �, .� p�7/ <br /> C1 <br /> -(P,, tars .7 <br /> D, we haves 0 "�ar-,e n•f ��e � b d�� �j! <br /> al> Ra" 9.'tst <br /> S S f�/,l �y�?»..e-I�s,� f-+; a S.e�'A'c �-: - �.rys at s 1 Y�.���v�l� � `.+ �' <br /> Describe septic installation to be installed: ba�� �oNse �o�r� s / �� �� 54,1P <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes _ No <br /> Stat deficiency: d W..GCS t P,y`e Z. w S 4�7 6eea <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: r <br /> 3. GARBAGE & REFUSE W-e <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> 4. FLY, MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: Aw <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISMRY . <br /> GENERAL SANITATIOid <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY / <br /> Appx, No. People per sq. mi. C r <br />