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1. SEWAGE <br /> Distance to Public Sewers ?Y_ Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #549: Yes No Unknown <br /> If no, explain: _ <br /> Describe <br /> s�,Apseptic installation to be installed: FL) <br /> I Cc W ar <br /> Additional information or comments:� <br /> � rn � <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No _ <br /> State deficiency: <br /> be- yJ/feZ <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 /> 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: -ko � <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> d. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY I <br /> Appx, No. People per sq, mi. L 9 {,y <br />