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1. SEWAGE <br /> Distance to Public Sewers ��: Connection necessary: i Yes No . <br /> Does existing septic system C-0- `ly With Ord. #'549; Yes. ' No <br /> If no, explain: _• Unknown <br /> Describe septic installation to be installed: <br /> Additional in-formation or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes -�• <br /> �-- �1° — Is w°�- proper: Yes <br /> State deficiency: = No <br /> Does existing or proposed use :Hake this well public water: Yes <br /> Sample of well water taken: Yes No <br /> Ito _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARnAGE & REFUSE <br /> Licensed scavenger. pick-up: Yes No <br /> — Service Area No. <br /> Other <br /> Proposed disposal method: <br /> ntial problem: <br /> 11. FLY SQUIM OR VECTOR POMTIAL <br /> State pos 'ble vector potential & necessary. ary control: <br /> $. AIR POLLUTION POMM <br /> State possible burning or recessing pollutants & n /-essary control: <br /> 6• TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY , <br /> ------------- <br /> d- GENERAL SANITATIO11 <br /> State any problems not previously noted: <br /> ------------------- <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. mi. <br />