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1. SEWAGE (2) . <br /> Distance W i'ublic Sewers Connection necessary: Yes _ No _ <br /> Does existing septic ayatem oomp�y with Ord. ;�>49: Yes No Unknown <br /> If no, .explain: . ' — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPFLY <br /> I* 'water supplied by private well: Yes _ Ho _ Is well proper: Yes <br /> No <br /> State deficiency: T <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: <br /> 3. GARBAGE & RE:FU SE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. at MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION PO T`N TI A L <br /> State possible burning or processing pollutants & necessary control: <br /> 6. MILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. i'hEVIOUS 01'i:itATION }iIS'IUItY <br /> 8. GENERAL SANITATI014 <br /> State any problems not previously no.,d: <br /> 9. POPULATION DENSITY <br /> Appx, No, people per sq, mi. <br />