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1. SEWAGE (2) <br /> Distance to Public Sewers <br /> Connection necessary: Yes (C-'No <br /> Does existing septic system comply with Ord. #549: .Yes No Unknown <br /> If no, explain: — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> L 141 <br /> Ns`�x� <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No Is well proper: Yes No 0%/,9 <br /> State deficiency: — <br /> Does existing or proposed use make this well public water: Yes No I1Y <br /> Sample of well water taken: Yes — No A F3ate Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE &, REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: _ <br /> Potential problem: _ <br /> 4. FLY, MOSQUITO OR VECIUR F. siv'TIALW <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTE14TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: - Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GEh-ERAL SANITATION <br /> State any problems not previa ,ly noted: - - <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq <br /> EH 06; o6 3/71 4/74 750 <br />