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1. SEWAGE <br /> i <br /> Distance to Public Sewers Conne.tion necessary: Yes _ No _ <br /> Does existing septic system (amply with 0 -d. #549: Yes _ No _ Unknown <br /> If no, explain: <br /> Describe septic installation -,,o be installed: <br /> Additional information or comm-:nts: <br /> 09 <br /> 2. WATER SUPPLY <br /> Is water supplied by private vx Ll: Yes _ No _ Is well pro,)er: Yes _ No <br /> State-dificency: <br /> i <br /> Does existing or proposed use make this well public water: Yez _ No _ <br /> Sample of well water taken: Yes No Date Taken Results <br /> Additional information or comment's: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: _ T <br /> "J�ial v.Lul �.i.J L11,G11 ; <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & nicessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or prgcessing )ollVtants & necessary control: <br /> 6. TOILE,T/BATH FACILITIES <br /> No. & location existing: Additional faci_ities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> Poll <br /> as �. <br /> GE1,ERAL SANITATION <br /> State any problems not previously noted: f <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />