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Distance to Public .;ewers Connection necessary: Yes ['o _ <br /> Does existing septic system comply with Ord. #519: 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 _ Fdo <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _ No <br /> Sample of well water taken: Y s _ No _ Date Taken/` Results <br /> Additional information or come ts: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes -7 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. TOIL&T/HA1H FACILITIES. <br /> No. do location existing: Additional facilities needed: <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GENERAL SMITATIO14 <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />