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1. SEWAGE <br /> Distance to Public Sewers <br /> Does existing septic system Connection necessary: i <br /> If no, explain: Yes ` No <br /> comply with Ord. I1�1,9: yes. No Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: L <br /> 4 � <br /> 2. WATER SUPPLYs AC <br /> xs water supplied by private wall: Yes No Is m <br /> .Mw <br /> State deficiency: proper: Yes� No � <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes No <br /> No _• Date Taken Results <br /> Additional information or comments: <br /> 3- GARMGE & REFUSE <br /> Licensed scavenger pick-up: Yes No <br /> s Service Area No. <br /> Other <br /> Proposed disposal method: • <br /> Potential problem: . <br /> F.Lyl MOSQUITO OR VECER POTENTIAL <br /> State possible vector <br /> Potential & necessary control: <br /> --------------- <br /> s- AIR PO LLU TION PO MMAL <br /> State possible burning or processing pollutants & necessary control: � . <br /> 6- TOILET BATH FACILITIES <br /> No. & location existing: <br /> ?- PREVIOUS* OPERATION HISTORY Additional facilities needed <br /> r <br /> o• CENTRAL SANITAT101, <br /> State any problems not previously noted: <br /> --------------- <br /> 9. FOPUTATIO14 DENSITY <br /> APPx- 140. People per sq. mi. <br /> -t2� / 5'�d[.Gl,�j �"JI d;f6e, <br /> LO) /✓,e f/,� ✓e�.� <br />