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1. SLWAGE <br />(2) <br />Distance to Public Sewers&jam o Connection necessary: Yes _ No <br />Does existing septic syste mply with Ord. #549: Yes No Unknown <br />If no, explain: <br />Describe septic installation to be installed: <br />Additional information or gomments: TA ate, o av, _o r � o � _071 <br />2. WADER SUPPLY <br />Is water supplied by private well: Yes _ No _ Is well proper: Yes _ 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 comment a <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 VECTOR POTENTIAL <br />State possible vector potential & necessary control: <br />5. AIR POLLUTION POTENTIAL <br />State possible burning or processing pollutants & necessary control: ZVO <br />6. TOILET/BATH FACILITIES <br />No. & location existing: <br />7. PREVIOUS OPERATION HISTO <br />8. GENERAL SANITATION <br />State any problems not previously noted: <br />9. POPULATION DENSITY <br />Appx. No. People per sq, mi. <br />EH 06 o6 <br />3/71 <br />Additional facilities needed <br />4/74 750 <br />