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1. SEWAGE <<� <br /> Distance to Public Sewers / �` � Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #50: Yos. No Unknown <br /> If no, explain: — — — <br /> Describe septic installation to be installed: <br /> Add'tional information or comments: rf <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes �/No Is well proper: Yes 4---No <br /> State deficiency: —" <br /> Does existing or proposed use make this well public water: Yes _ No ; - <br /> Sample of well water taken: Yes — No L% Date Taken _ Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE J- l�✓�^y a % / Uri w Q�.�G �l c? r c � �-- <br /> Licensed scavenger pick-up: Yes — No Service Area No. <br /> Other proposed disposal method: w <br /> Potential problem: <br /> 4. FLY] MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PRE US OPERATION HIS Y . <br /> C <br /> GENTRAL SANITATIO[d <br /> State any problems not previously noted: <br /> 9. iOPULATION DENSITY <br /> Appx. No. People per sq. mi. <br /> � � s <br /> GLo L/..)G4e .t <br />