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1. ,SEWAGE �`' <br /> Distance to Public Sewers Connection necessary: Yes _ No )L <br /> Does existing septic system comply with Ord. g5hg: Yes No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: U r . <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes No U <br /> State deficiency: ._ <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes _ No 2L Date Taken _ Results <br /> Additional information or comments: <br /> 3. GARBAGE & RE=FUSE It <br /> Licensed sca enger' pick-up: Yes _ No Service Area No. <br /> Other proposed •sposal method: <br /> Potential problem: <br /> 1i. FLY MOSQUITO OR VECTO RETIAL <br /> State possible vector pot e tial & necessary control: <br /> 5. AIR PO LLU TION PO MiTIAL <br /> State possible burning or processing 11;a nts & necessary control: <br /> 6. ZUILET/BATE{ FACILITIES <br /> No. & location existing: Additional facilities needed _ <br /> 7. PREVIOUS OPERATION HISTORY . <br /> j <br /> j <br /> d. GENT;RAL SMITATIOEJ <br /> State any problems of previously noted: <br /> 9. FOPULATIOIJ D NSITY <br /> Appx. No. P ople per sq. mi. <br />