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I. SEWAGE <br /> Distance to Public Sewers ; ' <br /> Connection necessary: } Yes No <br /> Does existing septic system comply with Ord. #'49: yes. _ No Unknown <br /> If no, explain: . <br /> Describe septic installation to be installed: <br /> Additional information or comments: 1 <br /> 2. WATER SUPPLY <br /> Is water supplied by private wolf: Yes � � ✓ Pal- <br /> Does <br /> Is well proper: Yes No <br /> State deficiency: .__., , <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: yes No <br /> No Date Taken Results <br /> Additional information or comments: <br /> 3. jk- <br /> GARDAGE & REFUSE - `-�•J/. <br /> � is .:c'"'rJ•.sy'3 W+-e-(1.1. <br /> Licensed scavenger pick-up: Yes _ No ` Service Area No. d - � a- <br /> z, <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> S• AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6• m ILET/BATH FACILITIES <br /> No. & location existing: ' <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY , <br /> el 00 <br /> d. GENERAL SANITATION <br /> State any problems not previously noted: _ <br /> 9. POPULATION DENSITY _ <br /> Appx, No. People per sq. mi. <br />