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1. SEWAGE (2) <br /> Distance to i'ublic Sewers !" /U_ Connection necessary: Yes _LX <br /> No <br /> existing septic system com ly with Ord. #549: Yes No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: 77 77 <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 deficiency: z <br /> Does existing or proposed use make this well public water: Yes V No <br /> Sample of well water taken: Yes _ No Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REl11SE <br /> Licensed scavenger pick-up: Yes �No _ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL r qq <br /> State possible vector potential & necessary control: �✓ //* <br /> 5. AIR POLLUTION POTEUTIAL J <br /> State possible burning or processing pollutants & necessary control: <br /> b. TOILET/BATH FACILITIES / <br /> No. & location existing: N/fy Additional facilities needed <br /> 7. 1-REVIOUS 01'EhATION HISTORY <br /> c��cQs <br /> 8. GENERAL SANITATION <br /> State any problems not previously noicJ : �p rl2 <br /> 9. POPULATION DENSITY o <br /> Appx. No. People per sq. Pa . K Ura � <br />