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} <br /> (2) <br /> 1. SEWAGE <br /> Distance to Public Sewers - �' Connection necessary: Yes � — <br /> Does existing septic system comply with Ord. #549: Yes _ No Unknown <br /> If no, ex lain: <br /> S¢- X033 C it ,E;� �, + , Wit <br /> Descr' septic installationy be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by priva a well: Yes ✓No _ Is well roper: Yes No <br /> State deficiency: C0k%.4;A i%S"l't4 nAg c{ �yLn� I" <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes <br /> � No�V Date Taken <br /> �� <br /> Additional information or commd A;,` Ll I � " � `7 ' -}'P-0 r� S�Q TZ <br /> 3. GARBAGE & REFUSE —7`^ <br /> Licensed scavenger pick-up: Yes No Service Area No. S <br /> Other proposed disposal method: <br /> —T <br /> Potential problem: <br /> 4. FLY, MOSQuiTo OR ucm itTENTIAL <br /> State possible vector potential & necessary control: ("„ <br /> T <br /> 5. AIR POLLUTION POTEN^1IAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES '�����rr�""""���� <br /> No. & location existing: _ Additional facilities needed <br /> 7. ?REBIOUS 01 LHATION HISTORY <br /> 8. GENERAL SANITATION <br /> State any prob ems not previously noi": >° �h � <br /> 9. POPULATION DENSITY �J / <br /> Appx. No. People per sq. mi. � �� <br />