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1. SEWAGE , <br /> Distance to Public Sewers Connection necessary: i Yes No <br /> Does existing septic system comply with Ord. #549: Yes' No U <br /> : nknown <br /> If rw, explain <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 /> State deficiency: No Is well proper: Yes _ No <br /> Does existing or proposed use make this wellwater: Yes ublic <br /> Sample of well water taken: Yes p No <br /> No Date Taken Results~ <br /> Additional information or comments: --- <br /> -- <br /> 3• GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -Z No <br /> Other proposed disposal method; Service Area No. <br /> Potential problem: <br /> �. FLY, MOSQUITO OR VECTOR. POTENTIAL <br /> State possible vector potential & necessary control. <br /> S• AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. m ILET/LATH FACILITIES <br /> No. & location existing: <br /> TORY , Additional facilities needed <br /> 7• PREVIOUS OPERATION HIS <br /> o. GEt,ERAL SANITATIOIJ <br /> State any problems not previously noted: ��9n' <br /> 9. FOPU LATION DENSITY <br /> APPx• ido. People per sq. mi. <br />