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1. SEIIAGE ( 2) <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: Yeo No <br /> Statea y: <br /> fi ienc <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-LSI:: Yes _ No Service Area No. <br /> Other proposed disposal rr_-.thod: <br /> Potential prablem: <br /> 4. FLY, MOSQUITO OR VECTaR F,r..,2 MAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TE14 TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BAH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 6. GENERAL SANITATION <br /> State any problems not previo sly no ted: Jcsz, �,� � �J, <br /> 9. POPULATION DENSITY <br /> Appx. No. People per so <br /> a O6 06 3/71 <br /> 4/74 750 <br />