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SEWAGE <br /> Distance to Public Sewers Connection necessary: i 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: ��'�s Ira <br /> cL S <br /> 2. WATER 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: �' �ra . , r 7',,� <br /> 3. GARDAGE & REFUSE �� ° U✓ 5 I� � ` <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION P0Tr,2ITIAL <br /> State possible burning or processing pollutants & necessary control: - <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing; Additional facilities needed <br /> 7. PREVI US OPERATION HISM �Y,f, _ <br /> 4 V .Y' P <br /> r <br /> GENT AL SANITATION <br /> State any problems not/previously noted:: <br /> 9. FOTIULATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />