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(2) <br /> 1. SEIWAGE <br /> Distance to Public Sewers Connection necessary: Yes No _ <br /> Does existing septic system comply with Ord. #'.549: Yes No Unknown <br /> If 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 comrsents: <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 POYENTlL <br /> State possible vector potential &_necessary cozlitrolm <br /> 5. AIR PO LLU TIO 4 PO TEN TIAL <br /> State possible burning- or processing. pollutants &..necessary, control <br /> 6. TOILET/BATH-FACILITIES <br /> No. & location_ existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY - <br /> 8. GENjERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br /> EH 06 o6 3/71 <br /> x/72 750 <br />