Laserfiche WebLink
1. SEWAGE <br /> Distance to Public Sewers � � <br /> Does existing septic Connection necessary: iYes <br /> Il no, explain: system comply With Ord. 50: Yes. No No <br /> • Unknown . . <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2• WATER SUPPLY <br /> Is water supplied by private well: <br /> State deficiency: Yes No Is well proper: Yes No <br /> Does existing or proposed use make this well public water: <br /> Sample of well water taken: Yes N No <br /> yes ..._ No � Date Taken '—' <br /> Additional information or comments: Results <br /> GARBAGE k REFUSE N4( <br /> Licensed scavenger pick-up: Yes _ <br /> No Service /area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> �. <br /> FLY1 MUSQUIM OR VEC'iUR POTENTIAL <br /> State possible vector <br /> Potential do necessary control: • <br /> 5• AIR POITJJTION P02EMAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. mILET BATH FACILITIES <br /> NO. do location existing: <br /> 7. PREVIOUS OPERATION IIISMRY Additional facilities needed <br /> j r <br /> d. GENT AL SANITATIO11 <br /> ,1 <br /> State any problems not previously noted:`07 �,,,� �. <br /> 0 <br /> 7 <� <br /> 9. FOPULATIO14 DENSITY ------------- <br /> Appx. i4o. People per sq. mi. <br />