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1. SEWAGE <br /> Distance to Public Sewers ' t Connection necessary: iYes No <br /> Does existing septic system comply with Ord. <br /> If no explain: N�49: yes. No Unknown <br /> Describe septic installation to be installed: <br /> Additional inform. ion or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _.... <br /> State deficiency: NO Is wall proper Yes No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: yes No <br /> t!o -._._ Date Taken Results <br /> Additional information or comments: 1 <br /> 3. GARBAGE & REFUSE G �ZLN'j'1 CLQ G'!yr S f <br /> Licensed scavenger. pick-up: Yes No <br /> Other proposed disposal — Service Area No. <br /> method: <br /> Potential problem: <br /> �. FLY MOSQUIM OR VECMR P2TD4TIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing Pollutants & necessary control: <br /> 6• TOILET/BABj FACILITIES <br /> No. & location existing: �J��� s <br /> ?• PREVIOUS OPERATION HISTORY , Additional facilities needed <br /> d. GEUERAL SANITATIO11 <br /> State any problems not previously noted: Z 6Th91 <br /> -------------- <br /> 9. POPULATION DENSITY <br /> Appx. 140. People per sq. mi. <br />