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(2) r <br /> 1. SEWAGE pp�� <br /> Distance to Public Sewers IUB Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #549 Yes _ No _ Unknown <br /> I£ 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 /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: /Vfl <br /> 5. AIR POLLUTION POTF14TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES '�L� p-5"OeA1vS <br /> No. & location existing: �v orK Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY to <br /> B. GENERAL SANITATION <br /> State any problems not previously noted: 0 0 <br /> 9. POPULATION DENSITY Q I� <br /> Appx. No. People per sq. mi. — 1lUf4l II otl(L dr4 <br />