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(2) �. <br /> Distance to i'ublic Sewers + Connection necessary: Yes _ I10 <br /> Does existing septic system comply with Ord. W�i,9: Yes -- No Unknown <br /> If no, explain: _ — —' <br /> Describe septic installation to be installed: <br /> Additional information or couunents: <br /> 2. ATER SUI-FLY <br /> Is water supplied by private well: Yes �_ _ Is well proper: Yes <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _ X <br /> Sample of well water taken: Yes tJo Date Taken Results` <br /> Additional information or comments: <br /> 3. GARBAGE & RgijSE <br /> Licensed scavenger pick-up: Yes "No Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR. VECTOR I-OMTIAL <br /> State possible vector potential & necessary control: <br /> 5. A rR PO LLU TION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. YUILET/BATH FACILITIES <br /> l+o. & location existing: Additional facilities deeded <br /> 7. 1'f&;VIOUS U1'LhATION HIS'[01tY . <br /> �S. GENERAL SAI,'I'rATIOIJ <br /> State any problems not hrc:viou ;ly no,-_J : <br /> 9. FOPULATION DENSITY <br /> Appx. No. People her sq. mi. <br />