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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes ` No <br /> Does existing septic system <br /> If no, explain: comply with Ord. I1.;O49: Yes. ._ NO _ Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> - <br /> 2. WATER SUPPLY <br /> Is water supplied by privato well: Yes <br /> NO ._ Is well Proper: Yes <br /> State deficiency; No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes No <br /> No _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No <br /> Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential do necessary control: <br /> S. AIR PO LLU TION PO TEtmAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 10ILET/BA71i FACILITIES <br /> NO- & location existing: <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION I{ISMRY <br /> o. GEIS-RAL SANITATIO14 <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> Appx, No. People per sq. mi. <br />