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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers T'� Connection necessary: Yeso V <br /> Does existing septic system comply with Ord. #549: Yes _ No _Unknown <br /> If no, explain: <br /> Le,i c l,�: v� .£s y 1`7Describe eptic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes i' No _ Is well proper: Yes No _7 <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: � a <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. TOILET/BATH FACILITIES <br /> No. & location existing: 1 Additional facilities needed i <br /> 7. PREVIOUS OPERATION HISTORY <br /> &, <br /> cs. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />