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�Lf <br /> 1. SEWAGE /�'�,�,,��,QQ 1 <br /> Distance to Public Sewers _fYlL'= Connection necessary: ; Yes _ 140 <br /> Does existing septic system comply with Ord. #549: Yes No Unk_nown _ <br /> If no, explain: �f C >SPaS <br /> � 7 r <br /> Desc llation to be installed: <br /> i <br /> Additional information or comments: ., <br /> ��► c/Ste' .. . . <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes jZNo Is well proper: Yes Noy <br /> State defic.ency: ,, 1� S Al doods ,}P +--L.-t e .7 <br /> Does existing or proposed use make this well public water: Yes _ No4__ - <br /> Sample of well water taken: Yes _ No _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential. problem: <br /> 4. FLY,r2,SQUITD 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: 0 <br /> 6. ToILET/BATH FACILITIES 17 <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS QPERATION HISTORY <br /> 4 <br /> cs. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq, mi. <br />