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(2) <br /> 1. SEWAGE <br /> Distance to i'ublic Sewers Connection necessary: Yes — No _ <br /> Does existing septic system comply with Ord. W549: Yes — No — Unknown _ <br /> If no, .explain:.:__._ <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> I(I=Vat er 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-'scavenge r pick-up: Yes _ No — Service Area No. <br /> Other proposed disposal method : <br /> Fotential problem: <br /> 4. FLY, MOSQUITO OR VECTOR F-OTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. ?REVIOUS 01,1 ihATIOIJ HISTORY <br /> 8. GE14MAL SANITATION <br /> State any problems not previously <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. n,i. <br />