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lel <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: ; Yes 140 L,� <br /> Does existing septic system comply with Ord. #549: Yes No Unknown _ <br /> If no, 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 No _ Is well proper: Yes _ No / <br /> State :deficientY ZT' d <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes _ No 4 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 meth <br /> 4. FLY, MOSQUI'W OR VECMR POTENTIAL <br /> State possible vector potential & n cessary control: <br /> 5. AIR POLLUTIOP! POMITIAL <br /> State possible burning or processing polluta is necessary control: <br /> 6. MILET/BATH FACILITIES / <br /> No. & location existing: additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> 6. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />