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1. SE4AGE (2) <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #549: Yes No Unknown <br /> If no, exp1 ' : — — <br /> , <br /> i <br /> Describe septic installation to be installed: <br /> Additional information or comments: — <br /> 2. WATER SUPPLY L d # /U <br /> t 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 _A--- <br /> Sample of well water taken: Yes — No t/ Date Taken Results <br /> Additional ytinftion gr�c_omme ts: 7 <br /> 3. GARBAGE & RE E �C•J� A-* 7 t /v <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: , ot <br /> - <br /> d 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br />' State�poss'ble � t - potential &//-necessary control: <br />:i <br /> 5. AIR POLLUTIO14 POTENTIAL <br /> State possiblp burning or processing!7 1 tants & n essary control: <br /> f <br /> 6. TOILET/BATH FACILITIES /T <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GEIaERAL SANITATION <br /> State any problems no� previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br /> EH 06 06 3/71 <br /> 4/74 750 <br />