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( 1 <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes 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 /> �7ce 19 � ; _ _10 ✓ <br /> 2. WATER 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 comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: � <br /> PotentSaTpxablem: er v <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTE14TIAL <br /> State possible burning or processing pollutants & necessary control: Al() <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> ln Sil� tlLLs� � <br /> 6. GENERAL SANITATION <br /> State any problems not previously noted: �— <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />