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1. SEWAGE <br /> Distance to Public Sowers <br /> Does existing septic Connection�nocessar <br /> system com 1 ' � Yos No <br /> If no, explain: P Y with Ord. J/�49; Yes. No Unknown <br /> Describe septic installation to be installed• <br /> In y �/y��✓i f /;plJcc� <br /> •�=.f'�d 'l�i`r�,f oma' ic -f�/1 <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private ~well: Yes ' <br /> State deficiency: X NO Is well properi Yes � . <br /> No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes tlo No <br /> Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE --- <br /> Licensed scavenger pick-up: Yes <br /> Other proposed dis ^ NO — Service Area No. <br /> Poul method; <br /> Potential problem: - <br /> �1. FLY MOSQUIM OR VECIUR P0IENTIAL <br /> State possible vector potential do necessary control: <br /> S. AIR POLLUTION POM,,TIAL <br /> State possible burning or processing pollutants & nocessary control: <br /> 6• IUILET/L1AT1i FACILITIL:S <br /> Ivo. & locution existing: ;.:: ' <br /> Additional facilities needed f <br /> 7. PREVIOUS OPERATION ltISTDRY <br /> C <br /> o. Gr1j'CRAL SANITATI011 <br /> State any problems not previously noted; �y, <br /> 9. POPULATION DENSITY <br /> Appx. iJo. People per sq. mi. <br />