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1. SEWAGE 2) <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. d549: Yea No Unknown <br /> if hog explain: — — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPFLY <br /> Iq"water supplied by private well: Yes — Wo Is well proper: Yes No <br /> S..t$te deficiency: — --r- <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 & REWSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. r <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR I0TENTIAL <br /> State possible vector potential & necessary control: <br /> S. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TUILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. ?REVIOUS 01,LitATION HISIURY <br /> 8. GENERAL SANITATION <br /> State any problems not previously no;,,-J : <br /> T <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. ati. <br />