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Distance to A•ublic Sewaara / ! v-7u Connection necessary: Yes No <br /> Does ex If i jng'tai ... Eye tea—'�'y with Ord. ,x;49: Yes _ No ` U�� <br /> Ueacribe sa tic installation to be installed: T / <br /> nal into <br /> S� <br /> 2. WA g I SUPFLY <br /> I Q 'va tar supplied b i� <br /> y private well: Yes No Is well proper: Yee 4---No <br /> Does existing or proposed use make this well public water: Yea No <br /> Sample of well water taken: Yes _ No �-' _ <br /> •. • bate Taken _ Results <br /> Additional information or comments: �,py <br /> 3. GARBAGE & RAUSE �ILL� r_ �• r <br /> Licensed•aq-avenger pick-up: Yes <br /> — No 'Service Area No. <br /> Other proposed disposal method • <br /> Fotential problem: <br /> �- FLY. MOSQUIM OR VECMR �QMTIAL <br /> State possible vector potential do necessary control: <br /> 5. AIR 1'OLLUTIG" i'O1"GIJ1'IA1, <br /> :3taLe posslo:e burning or Nroce:,;illr6 I,uliuLants & necessary control: <br /> G <br /> 6. <br /> 1U Li!:l;T Eit Tti FACILITIES <br /> ho. & location existing: Additional facilities needed <br /> 7. 'ft�VIUU ; ;'fI01d IlI ;'I;,i(Y <br /> <51 <br /> b• GENERAL :iA1,i i ATIotj <br /> :;LaLu arty hrobiems nut j,reviou:,ly <br /> 9. POPULATION DENSITY <br /> Appx. 14o. Veople per sq, nii. <br />