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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: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No _ <br /> State deficiency: Gt/Q,���,e../ ,p �. *rx. �y�. t,�,ch��4 � ✓7c<t� �A <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 & 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 PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: d Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 6. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq, mi. <br />