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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: } Yes _ No <br /> Does existing septic system comply with Ord. <br /> If no, explain: N�49: yes- <br /> If ` No _ Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes . ,.. <br /> No _.._ Is wellproper: Yes <br /> State deficiency: No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes _.__ t1No <br /> No __.._ Date Taken i_ ,Results <br /> Additional information or comments: <br /> 3. L,JuWAGE & REFUSE �l c� c' er-. <br /> Licensed scavenger pick-up: Yes _ No ._ Service Area No. <br /> Other proposed disposal method: J i Y <br /> Fo�sn-tial-problem: _ . -,. ; r �•-, y�1 — <br /> 4. FLY, MOSQUI� OR VECTnR POTENTIAL <br /> State possible vector potential & necessary control: <br /> S• AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6• TOILET/DATH FACILITIES <br /> No. & location existing: • <br /> Additional facilities needed 7. PREVIOUS OPERATION HISMRY , <br /> d. <br /> GE 14-E, SANI TATIO11 <br /> State any problems not previously noted: <br /> 9. FOPUTATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />