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2) <br /> 1. jEWAU6 <br /> Distance Lo ,'ublic Sewers Connection necessary: Yes No — <br /> Does existing septic system comply with Ord. Yes -- No _ Unknown — <br /> If no, explain: <br /> jescribe septic installation c04e installed: <br /> Additional information or cotimaants: <br /> 2. WATER SUFFLY <br /> Is water supplied by private well: Yes ✓ i+o Is well proper: Yes No <br /> :tate deficiency: <br /> Does existing or proposed use make this well public water: Yes ` No <br /> Sample of well water taken: tes — Pdo _ Date Taken Results <br /> Additional information or conaaents: <br /> 3. GARBAGE & 1W1JSE <br /> Licensed scavenger pick-up: 'f .•s '� NO _ Service Area Eo. <br /> Other proposed disposal method: <br /> Fotential problem: N 44 <br /> !�. FLY, MOSQUITO OR VEC'MR POTENTIAL <br /> State possible vector potential & necessary control: <br /> N n.,k Z& ,Xh-.14 :1 s: <br /> 5. AIR PO LLU TION PO TEN TI AL <br /> Mate possible burning or processing pollutants & necessary control: <br /> v—s- <br /> 6. iUILET/BATH FACILITIES <br /> No. & location existing: j W0 Additional facilities needea <br /> 7. i'iL6VIOU5 O1'i:,nATION HIS'EOHY <br /> �5. GEI,;ERAL SAWITATION <br /> State any problems not previously noted : <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. ria�� �_ <br />