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1. SEWAGE <br /> (2) <br /> Distance to Public Sewers CJUrConnection necessary Yes No" ✓ , <br /> Does existing septic system comply with Ord. #549: Yes No — Unknown <br /> Tf no, explain: W-- -- — <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes. V-'140 Is well proper: Yes �o <br /> State deficiency,: o^ a� — <br /> Does;ex' sting or proposed use make this well public water: Yes V,'No <br /> Sample of well water taken: Yes — NnDate Taken - Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE ; <br /> Licensed scavenger pick-up: Yes L.,- No Service Area No. , <br /> Other proposed disposal method : <br /> Potential problem: <br /> �a. FLY S,MOS UITO OR VECTOR POTENTIAL <br /> State possible vector potential necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing; Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY ' <br /> d. GENERAL SANITATION <br /> State any problems not ,previously noted : <br /> 9. POPULATION DENSITY ` <br /> Appx? No. People per sq. mi. <br />