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I. SEVAGE (2) <br /> Distance to .Public Sewers _ Connection necessary: Yes _ No �/ <br /> Does existing septic system comply with Ord. #549: Yes l�No Unknown <br /> If no, explain: — — <br /> Describe septic installation to be installed: Mees h lh 1 -Zlled <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes c,-' No Is well proper: Yes ✓ No <br /> State deficiency: 'i c'j l lvrat l,if(1 , ,f;y� c '-. i VS.- j 4-o i rr� hk 6� r J /lrul�erf� <br /> —�. ��, 11- ,r.-.r� /ACL J P <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-up: Yes L"/No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: _ <br /> 4. FLY, MOSQUITO OR VEC7 R ?= , y MAL f\j <br /> State possible vector pot-Fintial & necessary control: <br /> 5. AIR PO LLU TION PO TEid TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> No Era ( e V ^5 OCCv r r C, }- +ti i J <br /> s <br /> 6. MILET/BATH FACILITIES t\)111- <br /> ho. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GEIZRAL SANITATION <br /> State any problems not previo ly noted: None <br /> 9. POPULATION DLNSITY <br /> Appx. No. People per se L-OW denf� <br /> EH 06 06 _ 3/71 <br /> 4/?d 750 <br />