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a <br /> JrWAUE (2) <br /> Distance to i'ublic Sewera 1_11 <br /> 1 <br /> Does exia i Connection necessary: Yea _ No <br /> nK septic syst" oowp y with Ord. 4549: Yes No Unkno—wn <br /> It no, ezplaia: "` <br /> Ueacribe septic installation to be installed: Zt7�U <br /> Additional intorwtion or comments: <br /> 2. WAR SUPFLY <br /> Iq water supplied <br /> pp by private wall: Yes ✓filo Ia 11 proper: Ion tlo <br /> S.tr" deficieficy: <br /> Does existing or proposed use Rake this well public water: Yea _ No <br /> Sample of well water taken: Yes _ No ate, Taken �'�" Results~ <br /> Ad'ditiona'l information or comments: <br /> 3. GARBAGE & RF4jjSE <br /> Licensed scavenger pick-up: Yes _ No 'Service Area No. <br /> Other proposed disposal method: <br /> Fotential problem: <br /> 4. FLY, MOSQUIM OR VECTOR I-OUNTIAL <br /> State possible vector potential do necessary control: <br /> S. AIR POLLUTIO- "Or <br /> Mate possiu:e burning Ut. Proce:,:,lllg pul tuLanLs & necessary control: <br /> 6. M I LE T/SA Tt! FA CI LI T IES <br /> NO. & location existing: Additional facilities needed <br /> 7. I'hr;VIUU ; <br /> b. GENERAL SAKI TATIUII <br /> SLaLo ally problems 110L j,rcviou;.,ly j : <br /> 9- <br /> 9. POPUI.ATIUN DENSITY <br /> Appx. No. People per sq. mi. <br />