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1. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: YesNo <br /> _ +, <br /> Does existing septic system comply with Ord. #519: Yes —No Unknown <br /> If no, explain: — — <br /> ✓�- <br /> Describe septic installation to beinstalled: <br /> Additional information or comments: 7o' Comte zeo� ?j' <br /> 1V4" Of , <br /> ✓2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No ✓ Is well proper: Yes a 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: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger scavenger pick-up: Yes V' No _ Service Area No. .�f9�✓�iZlgR �jhif�P <br /> Other proposed disposal method : <br /> Potential problem: / �2e <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: —K. Additional facilities needed -� <br /> 7. PREVIOUS OPERATION HISTORY <br /> 00 " e3-/0/ ISP-x3-�7 <br /> b. GE14ERAL SANITATION <br /> State any problems not previously noted: <br /> 9. FOPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />