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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes _ No _ A <br /> Does existing septic system comply with Ord. #519: Yes _ No _ Unknown <br /> r , <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes v_ No Is well proper: Yes G No <br /> State deficiency: <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: -7 e �� ✓� irrlw ,7 <br /> 3. GARBAGE & REFUSE f U )97 5e + r <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: <br /> i <br /> 5. AIR POLLUTION POTENTIAL <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 /> 8. GENERAL SANITATION <br /> State any problems not previously noted.- <br /> 9. <br /> oted:9. POPULATION DENSITY <br /> Appx, No. People per sq. mi. <br />