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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system coi y with Ord. #519: Yes _ No _ Unkaown _ <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: Yea 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 /> Othsr proposed disposal method: <br /> Fotsntial proem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION PO TEN TIAL <br /> State possible burning or processing pollutants do necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. <br /> GENERAL SANITATION <br /> State any problems not previously noted: <br /> p. POPULATION DENSITY <br /> Appx. No. People per aq. mi. <br /> EH 06 06 3/71 3/71 750 <br />