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. : Llti 1�lrL' <br /> Distance to Public ;ewers 1,r1t 6c. 'Connection necessary: Yes i,o _ <br /> Does existing septic system comply with Ord . #549: Yes _ No _ Unknown x <br /> If no, explain: — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No \Z/— Is well proper: Yes _ Uo <br /> State deficiency: <br /> Does existing or proposed use make this well public water: YesNo <br /> Sample of well water taken: Yes No Date Taken //Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <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 <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES' <br /> No. & location existing: Additionalfacilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> �. GENERAL SANITATION <br /> State any problems not previously noted: ';_ <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br /> e� <br />