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1. SEWAGE k-1) <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #549: Yes. No Unknown <br /> IS 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: — —' <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 MI TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> b. `iOILET/I3AT14 FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISMRY . <br /> GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. 1'eople per sq, mi. <br />