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1. SEWAGE <br /> Distance to Public Sewers ,4`i r -' <br /> / 6'0 Connection necessary: Yes _ No _ <br /> Does existing septic system comply with Ord. #'hg: Yes. No Unknown t•. , <br /> If no, explain: <br /> N <br /> Describe septic installation to be installed: - <br /> Additional information o comments: A/ �' ��• S 6 5, <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> Ztata'8e xcitncy: <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes _ No ate Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE 096P--t,.r_-� <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TF3dTIAL <br /> State possible burning or processing pollutants cessary contrpl: <br /> 6. MILE,T/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> cs• Gl'uE Aj._&A#ITATIOII <br /> ro ems no <br /> 41 7 <br /> r96 <br /> 9. FOPU LATION DEN ITY <br /> Appx, No. People per sq. mi. <br />