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� 11 <br /> 1. SEWAGE <br /> Distance to Public Sewers 0011P- Connection necessary: Yes _ Igo 1- <br /> Does existing septic system comply with Ord. #549: Yes t/No Unknown <br /> If no, explain: —' — <br /> r s /5'4_cl- 77-t� <br /> Describe septic nstallation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPFLY <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 L,"' No Date Taken Results <br /> Additional information or comments: ZU- - -�2Ga_ <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes l._ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 1�. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION PO TE14 TIAL <br /> State possible burning or processing pollutants & necessary control: �{ <br /> 6. MILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. i'REVIOUS OPERATION HISTORY <br /> Wdtilli-5 almwds AFD barn 0-1- <br /> b. GENERAL SANITATION <br /> State any problems not previously noted : �/ dbL,-. <br /> 9. } OPULATION DENSITY <br /> r <br /> Appx. No. people per sq. mi. 4(1V <br />