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1. SEWAGE <br /> Distance to Public Sewers ',_\-, ' <br /> �� Connection necessary. . Yes � No _ <br /> Does existing septic system comply with Ord. N5L9= Yes. ' No Unknown <br /> If no, explain: -- <br /> 0 of S C f� l <br /> Describe septic installation to be installed: C6 Cfia„t <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is Water supplied by private well: Yes No Is L1 proper: Yes No <br /> State deficiency: j VC. S fA c LLy v <br /> 40. <br /> Does existing or proposed t <br /> sed 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-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> !�. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TI3dTIAL <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 . r <br /> cs. GENMRAL SANITATIOII <br /> State any problems not previously noted: <br /> 9. COPULATION DENSITY <br /> Appx, No. People per sq. mi. <br />