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(2) <br />i. SEWAGE <br />Distance to Public Sewers Connection necessary: Yes No . <br />Does existing septic system comply with Ord. #519: Yes IJo 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: <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 />l�. 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. `MILET/BATH FACILITIES <br />No. & location existing: <br />7. PREVIOUS OPERATION HISTORY <br />b. GENERAL SANITATION <br />State any problems not previously noted: <br />9. i OVULATION DENSITY <br />Appx. No. People per sq. mi. <br />Additional facilities needed <br />