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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. 4549: Yea No Unknown <br /> If nog explain:""- — — — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> 10 'water supplied by private well: Yes I-Jo Is well proper: Yes No <br /> S,t$te 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 & RSI SE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR I-OTENTIAL <br /> State possible vector potential & necessary control: <br /> S. AIR POLLUTION POTEIMAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. i'REVIOUS 01-LitATION HISIC)HY <br /> 8. GENERAL SANITATION <br /> State any problems not previously no t,J : <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />