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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: iYes No '_ <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: te <br /> 2. WATER SUPPLY <br /> Is water supplied by private we Yes — No Is well proper: Yes No _ <br /> _ at8 defci�encyi +.. �S- <br /> e <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: AJo ' , � '" , Wiz-P <br /> 3. GARBAGE & REFUSE S ;Z3 _NFJ r 5 � �-� , /Soa"^TQ' 4?-e &-,; <br /> Licensed scavenger pick-up: Yes _ No Service Area No. p410 'I �`� <br /> Other proposed disposal m hod: If-9.A-,� t-�. y%" CAP Ll � <br /> F--o-tantial problem: <br /> 4. FLY, MOSQUITO OR VECTOR. POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TE14 TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 1 <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> cs. GENERAL SA14ITATIO14 <br /> State any problems not previously noted: t �/�c y S <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />