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1, SEWAGE <br /> Distance to Public Sowers Connection necessary: Yos .! No <br /> Docs existing septic system comply with Ord. J/i49: Yes. No Unknown _ <br /> If no, explain: — <br /> �lJ�'„�%� /�i,✓fid <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY - <br /> Is water supplied by private well: Yes <br /> State deficiency: No <br /> — Is �'ou Properi Yes No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample or well water taken: No <br /> Yes _ 110 '� Date Taken Rosulta <br /> Additional information or comments: <br /> 3. GAIMCE <br /> Licensed scavenger pick-up: Yes _ <br /> Other N0 Service Arca No. <br /> Proposed disposal method: may,.- <br /> Potential problem: <br /> 4. FLY MUSQU24p 011 VF,CTOR PO'11?1TIAL <br /> State possible vector <br /> Potential & necessary control: <br /> S. AIR POLLUTION POT7i1dTIAL <br /> State possible burning or processing pollutants & necessary control: F <br /> 6. 'IOILEVaATI{ FACILITIl <br /> No. & location existing: <br /> ?. PREVIOUS' OP$RATION HISIURYAdditional facilities needed, <br /> • fc`F <br /> d. GrIMIAL SANITATIO11 <br /> State any problems not previously noted: <br /> �-f <br /> 9. POPULATION DENSITY <br /> APpx• j10. People per sq. mi. �1y4i9y Cc ro, �if(��y <br />