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I- SEWAGE L 1 <br /> Distance to Public Sewers <br /> Connection necessary: . Yes No <br /> Does existing septic system comply with Ord, — <br /> If no, explain: //�49: Yes _ No ._ Unknown <br /> Describe septic installat±co7e <br /> instal ed: <br /> Azz-o Additional it�o 4rmation or p �c.� <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Ism ro <br /> State deficiency: �ifL �� 7 ! proper: Yes _ No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes P _ No <br /> 170 _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARDAGE & REFUSE <br /> Licensed s veneer pick-up: Yes _ No _ Service Area No. <br /> Other propo�d disposal method: <br /> Potential prob em: <br /> 4. FLY MOSQUIIU 0 VECIUR POT1?d1TAL <br /> State possible vec r potential & necessary control: <br /> 5. AIR POLLUTION POMNTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 1UILET/DA711 FACILITIES <br /> No. & location existing: <br /> 7Additional facilities needed <br /> . PREVIOUS OPERATION I[ISMR <br /> &. GENERAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> APPx• IJo. 1'eop1c per sq, mi. <br />