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Distance to i'ublic ;:ewers ( Z ����-2onnection necessary: Yes '4k�I:o _ <br /> Does existing septic system comply with Ord . #549: Yes _ No _ Unknown <br /> If no, explain: _ <br /> Szp we. w-Jev (LILT-- I <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY j' 0 V O J -e� e d( <br /> Is water supplied by private well: Yes _ No _ Is well proper: Yes _ fdo <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: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> i1ave1, /2 t 3 <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> b. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. a k� iii+'A I; �7 <br /> t <br />