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1. :itb1AUE (71. <br /> Distance to :'ublio Sewer• Connection necessary: yes No <br /> Does existing septic If systsn Coo—�wp y—with Ord. 4549: rem No — Unknovr,, <br /> Describe septic insOallation to be installed: <br /> Additional informtion or tomenta:. .._ . <br /> 2. WATER SUPPLY' <br /> IQ *w4W supplied,by private well: yes "✓No Is well proper: Tee No <br /> S,t9te deficiency: _ —' -.— -- <br /> "—�� <br /> Does existing or proposed use make this well public water: Yea No <br /> Sample,-of well water takan'e- yes _ No Date Taken <br /> ` ._ Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scaveryber pick-up: . Yes No 'Service Area No. <br /> Other <br /> Proposed disposal methods' <br /> Potential problem: - <br /> 6. FLT, M0SQUI10 OR VECIUR FOlENTIAL - - <br /> ',Late Possible vector potential & necessary control: <br /> $. AIk 10LLUTIG:: i'O7c11TIAL <br /> Latepo sslu:e bur <br /> n1nL or Processing l.uliutants & necessary control: <br /> 6. 12II.hT/BATH FACILITIES <br /> ho. & location existing: Additional facilities needed <br /> 7. Iu VIOU W ;TION II1ST tY <br /> b, (EGEILIL SAI:i7ATIUN <br /> vLa Lu 61V problems not „reviously <br /> POPULATION DENSITY <br /> Appx- ilo. ' <br /> People per sq, roi. <br />