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1. SEWAGE <br /> Distance to Public Sewers _ � Connection necessary: iYes _ No <br /> Does existing septic system comply with Ord. #':)49: Yes. No Unknown a <br /> If no, explain: <br /> Describe septic installation to be installed: res�'cQfc< ' .( <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes _ No <br /> n <br /> State deficiency: V <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 <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: [-�Pucor�l' a (f_'LVS+- a .� ,Oct � <br /> 4. KLY, MOSQUITO OR VECTOR POTENTIAL <br /> Sta possible vector potential & necessary control: <br /> 5. AIR POLLUTION PO TIAL <br /> State possible burn or processing pollutants & necessar x6'ntrol: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY . <br /> &. GENERAL SANITATIO14 <br /> State any problems not,,previously noted: <br /> i <br /> 9. POPULATION r.NSITY <br /> Appx. IN , People per sq. mi. <br />