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1. SEWAGE <br /> Distance to Public Sewers i <br /> Does existing Septic systeConnection necessary: iy©s No <br /> m comply with Il Ord. Yes•no, explain: No Uno wn . <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private woll: Yes ... <br /> y No well proper:' Yes — No <br /> State deficiency: �I � '.G•� <br /> 0,40 . <br /> Does existin or ro ¢ E� ��'�'� f/oma �,,�c..•�/ —� <br /> proposed use make Ls ire public ua r•� Yes — No <br /> Sample of well water taken: Yea <br /> 110 Date Taken Results <br /> Additional information or comments: ------•=-- <br /> 3. GAItl3AGE & REFUSE <br /> Licensed scavenger pick-up: Yes No ' <br /> ---- --- Service Area No. <br /> Other proposed disposal <br /> method; <br /> Potential problem: <br /> 1�. FLY MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTTAL <br /> State possible burning or processing <br /> Pollutants & necessary control: <br /> 6• 1dILET�DATH FACILITIES <br /> No. & location existing: <br /> ?• , Additional facilities needed <br /> PREVIOUS OPERATION HISTURY <br /> d. CEVERAL SANITATIO11 <br /> State a I • <br /> ny problems not previously noted: r,-- <br /> 9. POPULATION DENSITY <br /> APPx. 140. 1'eople per sq. mi. <br />