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1. SEWAGE <br /> Distance to Public Sewers r/ir Yaclvm Connection necessary: iYes _ No <br /> Does existing septic system comply with Ord. #549: Yes. No Unknown <br /> If no, explain: - -- — <br /> Describe septic installation to be installed: 07�' 9 �� t <br /> d�i�t�onal information or comments; <br /> 2. WATER SUPPLY <br /> Is water supplied by private wall: yes No Is well proper: Yes l No M <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 comments: <br /> 3. GARUGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. F70SQUIYU OR VECR)R POTENTIAL <br /> State possible vector potential & necessary control: <br /> S• AIR POLLUTION POMITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. miLET/IlAT({ FACIISTIES <br /> No. & location existing: G�iif'9 �E�d6.lfr✓� 'r <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY , <br /> a. GENERAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. ;4o. People per sq. mi. /� ��'®�� �04,gi7, <br />