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1. SEWAGE <br /> • 1 ; <br /> Distance to Public SewersConnection necessary: i Yes No _ <br /> Does existing septic system comply with Ord. J#j49: Yes. No _ Unknown <br /> IS no, explain: '— <br /> Describe septic installation to be installed: IXOJ " X, F.- .-• �/' f ,,! ,�; <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is Water supplied by private well: Yes ...�. No Is well properi Yes ..-... No <br /> State deficiency: 4'/flG �r.✓r� .� /�.w/'� = ::M�'�,�„>, ��,i e��: <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: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential necessary control: i <br /> 5. AIR PO LLU TION PO MI TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY ; <br /> i3. GENT AL SA14ITATIOIJ <br /> State any problems not previously noted: <br /> 9. FOPULATI014 DENSI'T'Y <br /> Appx, No. People per sq, mi. <br />