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( 2) <br /> 1. SEWAGE <br /> Distance to Public Sewers ,! Connection necessary: Yes _ No �' <br /> Does existing septic system comply with Ord . #549: Yes _ No _ Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: - <br /> Additional information or comments: _77-57-4- <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes � Is well proper: Yes V, 140 <br /> State deficiency: <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: i0_111 C <br /> 3. GARBAGE & REk`USE 0 <br /> Licensed scavenger pick-up: Yes %-""'No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITC) 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: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 6. GE14ERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. mi. �� <br />