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1. SFWAcr <br /> Distance to <br /> Does existingu septic <br /> Sowers -- Connection necessary: I <br /> P septic Y Yes No <br /> Il no, explain: system comply with Ord. N.> yes. No Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATEnSUPPLY _ . <br /> Is water supplied by Private ue <br /> State deficiency: �' Yes Now . <br /> Is well propori Yes No <br /> Does existing orro <br /> P posed use make this well public water: Yes No _ <br /> Sample of well water taken: Yes No <br /> Additional information or comments: Date Taken Rosults <br /> 3. GARBAGE & RL:FUSE <br /> Licensed scavenger pick—up: Yes _ No Service Arca No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> u. FLY MoSQu M OR VEC10R PO11?dTIAL <br /> State possible vector <br /> Potential & necessary control: <br /> 5. AIR POLLUTION P017]4T,.r <br /> State possible burning or processing pollutants nocess <br /> uy control: <br /> 6. MILET/RAW FACILITIES <br /> No. & location existing: <br /> 7. PREVIOUS OPERATION I(ISZORY Additional facilities needed . <br /> --------------- <br /> n. CEIIERAI. SANITATION <br /> State arty problems not previously noted: <br /> 9. FOPUL.ATIO14 DENSITY <br /> APpx• Iso. People per sq. mi. <br />