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1. SEWAGE: <br /> Distance to Public Sewers . <br /> Does existingseptic � Connection necessary: } Yes _ No � d <br /> P system comply with Ord. 11��9: yes. No Unknown <br /> Il no, explain: ,_._ ,. <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is avatar supplied b <br /> y private well: Yes No _ Is well proper: Yes <br /> No . ~ <br /> State deficiency: <br /> Does existing or proposed use make this wellwater: Yes ublic <br /> Sample of well water taken: yea PNo <br /> _ Ere _ Date Taken Results '• <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE ----_:-- <br /> L.�•.>�a'-� ,.- ,����----•��� ISP <br /> Licensed scave <br /> nEer pick-up: yes No Service Area No. <br /> Other proposed disposal method: _ <br /> Potential problem: <br /> fit. FLY MOSQUIM OR VEC'I'QR POTENTIAL <br /> State possible vector potential & necessary control: <br /> S• AIR POLLUTION POMMAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. mILET/DATH FACILITIES <br /> No. & location existing: <br /> 7. PREVIOUS, OPERATION HISTURyt Additional facilities needed <br /> Az <br /> o. GE147,MAL SANITATIOIJ <br /> State any problems not previously noted: r <br /> 9. POPULATION DENSITY <br /> Appx• 140. People per sq. mi. <br />