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1. SEWAGE <br /> Distance to Public Sewers ' <br /> Does existingseptic Connection necessary: • Yes No <br /> If no, explain: P system comply with Ord. #-49: yes. f No Unknown . . <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes ..... <br /> State deficiency: NO _ Is well Proper: Yes <br /> Does existing or proposed use make this well public water: Yes <br /> Sample or well water taken: yea .� No <br /> No . Date Taken Results <br /> Additional information or comments: <br /> 3• GARBAGE & REFUSE -- <br /> Licensed scavenger pick-up: Yes No <br /> s — Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: . <br /> 1�. FLY MoSQUI`[n OR VECZOR POMTIAL <br /> State possible vector Potential be necessary control: <br /> S• AIR POLLUTION PO MMAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6• MII.WRAW FACILITIES <br /> 7. <br /> NO- & location existing: <br /> Additional facilities needed <br /> PREVIOUS OPERATION 11ISMRY , <br /> d. GENERAL SANITATI011 <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> APPx• 140. People per sq. mi. <br />