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( 2) <br /> • x <br /> Distance to eublic Sewers Connection necessary: Yes No <br /> Unknown <br /> Does existing septic system comply With Ord. #1549: <br /> Yes NoIf 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 /> LicenseA 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 POLUJTION POTE4TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 'TOILET/BATH FACILITIES <br /> Additional facilities needed <br /> No. & location existing: <br /> 7. PREVIOUS OPERATION HISTORY <br /> i3. GENERAL SAN I TATIO14 <br /> State any problems not previously noted : <br /> 9. 101'ULATION DENSITY <br /> Appx. No. People per sq. mi . <br />