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J <br /> SEWAGE (2) <br /> Distance to i'ublic Sewers) -;�1� �' Connection necessary: Yes �No <br /> Does existing septic system comply urith Ord. d5i1q: Yes No u/ Unknown <br /> If no, explain: —` <br /> At IJ s�-nQ L����h� - l'���Ilf� Mil/�i'i%'I'!l�1� r SW <br /> /C � � <br /> Uescribe septic installation to be installed: <br /> Additional information or coiaments: e S76,bWvbf�L <br /> Ze 't'-ec.l' au !f�9 t e-P ✓��,et A ,11 r'1r �� tr �; a� s'i1 ck fi <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ lio L/ Is well proper: Yes _ No <br /> State deficiency: <br /> Does ex}sting or proposed use make this, well public water: Yes _ No <br /> Sample of well water taken: Yes 110 Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & RERJSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR. VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POL.I.UTION PO'TUITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6.- TJILET/BATki FACILITIES <br /> l,o. & location existing: Additional facilities needea <br /> 7 . rltr vIOUS oi-L.,tAnow 1{I:;'[U1{Y <br /> O T <br /> b. GENERAL SAW11TATION <br /> State any problems not pruviuu;;ly noL._.i : A// <br /> 9. FoPuLATIOIJ Dr;NSITY <br /> Appx . iJo . 1'copl o! pt:r :.q• r+. -- <br />