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(2) <br /> 1. SEWAGE <br /> Distance to i'ublic Sewers ' • Connection necessary: Yes _ No / <br /> Does. existing septic system comply with Ord. d549: Yes — No _ Unknown — <br /> - '� :�-? ,�..�. "1+-.,� 1 n �.-',ice .�.�-,� �.�.� �� � � / � / e,r •�� -�? :,Y�! <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY j-=r GG�� / <br /> Iq-`.vatet-supplied:by private well: Yes Ho Is well proper: Yes th <br /> S,ti'te- d`eYiciericy: --r- . <br /> Does existing or proposed use make this well.public water: Yes No <br /> Sample of well water taken: Yes _ No Date Taken Results <br /> Additional information or comments: ,? <br /> 3. GARBAGE & REFUSE �-r' r f y 1,,,'C, � .. may, <br /> Licensed scavenger pick-up: Yes _ No Service Area No. ,� J ► f, <br /> Other proposed disposal method: <br /> Potential problem: ,c <br /> 1t. -FLY; MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> $. AIR POLLUTION POTEIITIAL <br /> State possible burning or processing pollutants & necessary control: r <br /> 6., TOILET/SATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. ?MVIOUS 01'LitATION HISTORY <br /> 8. GENERAL SANITATION <br /> State any problems not previously no;:cd: <br /> 9. POPULATION DENSITY <br /> Appx iso. People per sq. vii. <br />