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1. SEWAGL _ (2) <br /> Distance to Public Sewers ' <br /> onnection necessary: Yes No ✓ <br /> Does existing septic system comply with Ord . #549: Yes No Unknown <br /> If no, explain: . <br /> S t <br /> Describe septic installation to be installed: <br /> Additional information or comments. qk <br /> .4 . . _ <br /> 2. WA SUPPLY - <br /> #� i0TX watTros-aplied by private well: Yes � 140 Is well proper: YesState ency: <br /> z <br /> Does -existing or 'proposed use make this well, public water: Yes No * <br /> Sample of well water taken: Yes Date aken . Results <br /> Additional information or comments: <br /> 3. G1.RUG;, &�SE_ r. _ <br /> License�d scavenger pick-up:" Yes No Service Area <br /> Other proposed disposal= method: <br /> Potential problem: <br /> 4. FLY,"MOSQUITO OR VECTOR POTENTIAL <br /> State jpo`ss'ble ve for potential & necs Bary control: <br /> 5• AIS PO LLU TION PO T'EN TIAL _ <br /> State possible burning or processing pollutants & necessary control: <br /> E i <br /> 6. 2ILET BATH FACILITIES <br /> No. & Location existing: — � Additional facilities needed <br /> 7. PRF,VIOUS OPERATION HJST6AY 1` .,Q - Y <br /> 1 <br /> GENERAL SANITATION '` V`° <br /> State.any problems not prey ausly.noted: <br /> s - <br /> 9. POPULATION DENSITY ' GA 7PJ- <br /> � <br /> Appx„. No. Peopleq er s • mi. <br /> p L5( <br />