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1. SEWAGE (2) <br /> Distance to Public Sewers 0011t, Connection necessary: Yes ✓ No <br /> Does existing septic system cc ly with Ord. #549: Yes gA)-No _ Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: /LX <br /> Addit}}oval inf9rmation or comments: e-f l <br /> I <br /> LA i`-f r 5 GU/ct /1��� — man � hLLi� U � i � 5 ct va <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ NoIs well proper: Yes _ No <br /> State deficiency: <br /> Does existing or proposed use make this well p is water: Yes No _ <br /> Sample of well water taken: Yes No _ ate Taken 7�— Results <br /> t <br /> Additional information or comments: d/�ST <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: YesNo _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, NYJSQUITO OR VECTOR POTENTIAL , / <br /> State possible vector potential & necessary control: N/11 <br /> 5. AIR POLLUTION POTE14TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTO Y <br /> 0 gin <br /> r ' <br /> b. GENERAL SANITATION <br /> State any problems not previously noted: k/0 tv- <br /> 9. POPULATION DENSITY _�n ,^_�__,!� c 0 � <br /> Appx. No. People per sq. mi. P 5 1 w� <br />