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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers LI )6)/,{, Connection necessary: Yes _ No <br /> Does. existing septic system comply with Ord. 4549: Yes -ZNo Unknown <br /> If iso, .eipla1n:_- <br /> Describe septic instal to be installed: <br /> Additional information or commen/)ts• L p 1,'e, 0 U3 a of � <br /> !i l r j �QJ�C�kI C /�- Cd6-4— I <br /> 2. WATER SU LY < <br /> I =Watet supplied by private well: Yes i__�too Is well prop r: Yes l%1.10 <br /> S,t-I a .aeficieiicy: �' -*- <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes _ No L Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE ` <br /> Licensed scavenger pick-up: Yes L No — Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY;' MOSQUITO OR VECMR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION PO`I ITIAL <br /> State possible burning or processing pollutants & necessary control: NIA <br /> 6.; TOILET/BATH FACILITIES <br /> No. -& location existing: �—� <br /> �� Additional facilities needed <br /> 7. ?MVIOU5 01,Z CATION HIS`IORY <br /> �i Q �' ► a�a, �'1 v t -� G_32 <br /> S. C&iT.RAL SANITATION �, J <br /> State any problems not previously no cd: <br /> 9 POPUI:ATIUN DENSITY i <br /> APPx•. No Peopleper sq. mi (.�J� <br /> q <br />