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1. SEWAGE «� <br /> Distance to Public Sewers Connection necessary: iYes _ No <br /> Does existing septic system comply with Ord. #549: Yes No _ Unknown _ <br /> If no, explain: <br /> - - �y �� <br /> Describe septic installati�to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes 4 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 ArQ2 No. <br /> Other proposed disposal method: <br /> Potentialproblem: <br /> 4. FLY MOSQU U OR VECTOR POTENTIAL <br /> State possibl vector potential & necessary co rol: <br /> 5. AIR POLLUTION POTEN <br /> State possible burningo processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> is. GENERAL SANITATIO14 / <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />