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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: iyesNo <br /> Does existing septic system comply with Ord, #549: Yes. No Unknown <br /> If no, explain: — — <br /> Describe septic installation to be installed. <br /> Additional information or comments: <br /> 2. WATER SUPPLY ~ <br /> Is water supplied by private wolf: Yes No Is vie]] proper:State deficiency: "— — P per: Yes No <br /> Does existing or proposed use make this well public water: Yes _ No <br /> Sample of well water taken: Yes No Date Taken - <br /> - Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger, pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VEC10 R POTENTIAL <br /> State possible vector potential & necessary control: <br /> S. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/SATi{ FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION fiISTORY , <br /> b. GMgCRAL SANITATIO14 <br /> State any problems not previously noted: <br /> 9. FOPULATION DENSITY <br /> Appx, No. People per sq. mi. <br />