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1. StWA(]k; {21 �.... <br /> Distance to "ublic Sewers <br /> Does exis Connection necessary: Ysa Ko . <br /> ti�lL s!p`lo q�t�est :with Ord. J549: Yes No _ D <br /> It .no, a"Xpl '..`r '°.. .._ nknowu . . ; <br /> T_:..4aacribe saptie lnataYlation to`be installed: i <br /> v Add" i,onal informs t on or <br /> WA1ER"'SUPPLY �x. <br /> 'xitter supplied, tiyprlva to well: res s, <br /> �• . ; <br /> `lJo .ie., Von proper:.: Yee <br /> Does existing or proposed use make thiswell public water: Yea -• No v <br /> Sample.,•af..well Ovate ri`" Yes H <br /> .. r take o Date Taken Resttlta" <br /> dtionsl information or comments: .- <br /> 3• GARBAGE & REnSE IF <br /> Licens®d.,Bca ventger <br /> pick-up; Xe°s ho Service Area No. .... _ _ <br /> Otherpro _. <br /> posed disposal method <br /> Potential problem. ... <br /> �- FLT MOSOUTTn OR IIECIC)R W-MMAL <br /> S to to - .•;. . <br /> possible vactor' potential & necessary control: ---� <br /> 5. Aft yl'OLWTItr'OTGIJTIAL r' <br /> :Late: burning; or rocv;i:;jil • i . . y . <br /> p � • x�l,tuLanLs & nece.ssar control;. .• :.� ' •- a <br /> b- T MM FACILITIES - <br /> �a- & J_OCaLion axistil3g: <br /> Additional facilities needed G <br /> 4']u:V1UU:; 01 .- ;r1014 111:;'1.,ay50 <br /> C <br /> All <br /> , <br /> :iAl:i'iAI'iUI] <br /> iLaLu ajV problems nuL j.ruvlpuzjy <br /> a <br /> • <br /> 1 <br /> :'. POPULATION DENSIT7 <br /> Appx. i'Io- Veople per sq, Ali . <br /> • r <br />