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Distance to i'ublic Sewers / <br /> /�, y7��' Connection necessary: Yes _ Ido .- <br /> Does existing septic system comply with Ord, d51r9: Yes No <br /> if no, -explain: _ Unknown _ <br /> Describe septic installation to be installed: <br /> Additional iriforma tion or comments: _. <br /> 2. WATER SU?FLY <br /> Is water supplied by private well: Yes <br /> Stated y.-enc — 1'O _. Is well proper: Yes No <br /> Does existing orro r <br /> p posed use make this, well public water: Ye i10 f pl <br /> Sample of well water taken: Yes _ No Date Taken <br /> - Results --� <br /> Additional information or comments: <br /> 3. GARBAGE & USE C /ice <br /> REFUSE <br /> Licensed scavenger pick-up: Yes _ <br /> Other proposed disposal method : No Service Area No. <br /> 0­tenLia4_ problem: ,�� t"' ry <br /> Lr. FLY MOSQUITO. OR. VECTOR 1-OTF MAL �r <br /> State possib e vector potential & necessary control: <br /> 5. Ai, 1112tUTION PO1UITIAL <br /> State possible burning; or processing pollutants & necessary control: <br /> 6. 'MILET/BATH FACILITIES <br /> Igo. & loca pion exiating: <br /> Additional facilities rreedea <br /> 7. cftEvIUU::; U1 .:rtA'rI0IJ III:;'11)1cY <br /> / _0 <br /> b. GE1III L jANITATION <br /> State any problems not arc viuu ay <br /> no <br /> 9. POPULATION DEN lry <br /> Appx, ;Jo . I'eople per <br /> i <br />