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(2) t <br /> Distance to i'ublic Sewers n` onnection necessary: Yes No <br /> Does existing septic system omply with Ord. d>ci9: Yes Ido Unknown <br /> If no, explain: -- <br /> Describe septic installation to be installed: <br /> Additional information or coiments: <br /> 'T(xr'T <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes1W <br /> No Is well proper: Yes 1' <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes _ ijo o�ate Taken _ Results <br /> Additional information or comments: 1 ar-c esvk q �( <br /> 3. GARBAGE & FLEMJ SE d; " D _�t <br /> Licensed scavenget pick-up: Yes ""No _ Service Area No. <br /> Other proposed disposal method: �— <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR. VECTOR I-OMNTIAL <br /> State possible vector potential & necessary control: <br /> 5. <br /> aR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 'IUILET/BATH FACILITIES <br /> ho. & location existing: Additional facilities needed d0- <br /> 7. 11LEVIOUS 01,LhATIOI4 HIS'[0H <br /> 1 <br /> b. GEI-ERAL SAWITATIOId <br /> State any problems not previously no ,..J: <br /> 9. FOPULATIOIJ DENSITY �- <br /> Appx. No. People per sq. mi. Cj <br /> 1 <br />