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1. SEWAGE <br /> Distance to Public Sewers �c� Connection necessary: Yes _ No " <br /> Does existing septic system comply with Ord. #549: Yes. No Unknown <br /> If no, explain: / ,�,`- —" <br /> i r Gv2 5 �J, 7 .G <br /> Describe septic installation to be installed: 74 <br /> 2-2-S <br /> Additional information or comments: 7 Pte-/' /, �/� a 1// e � <br /> -f-7 <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No <br /> State deficiency: <br /> p � <br /> /Pjt✓ L✓� l S G/'"S P /Jo y �ar< (� ��Lr fi/e B,, <br /> eel". <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: <br /> 5. AIR PO LLU TION PO TSN 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 /> rip <br /> b. GmzmAL SANITATIo[1 <br /> State any problems not previously noted: /Vd� <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq. mi. f 9- . <br />