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( 2) <br /> Distance to Public Sewers Connection necessary: Yes No a <br /> Does existing septic system comply with Ord. #5h9: Yes No Unknown <br /> If no, explain: <br /> l c- L) <br /> Describe septic installation to be installed: R' <br /> CL <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No _ Is w611 proper: Yes Ho <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: eh <br /> 3. GARBAGE & REFUSE f CJG��( 5� s�'t 'f c��t _•� .2-�t. L-!- <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Fotential problem: <br /> h. 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/SATH FACILITIES <br /> Additional facilities needed <br /> No. & location existing: <br /> 7. PREVIOUS OPERATION HISTORY <br /> v. GENERAL SANITATION <br /> State any problems not previously noted .- / <br /> � All t Lam, <br /> 9. i-OPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />