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, <br /> 1. SEWAGE (2) . <br /> Distance to Public Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. #519: Yes _ No _ Unknown _ <br /> If no, explain: <br /> Describe septic installation to be installed: r A <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Z. <br /> Is well proper: Yes _ No <br /> State deficiency: &IINCG U✓� ft,I lj Z. Ids <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 �L 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: �dh2_ <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing qolluants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GE14ERAL SANITATION / <br /> State any problems not previously noted: <br /> 9. FOPULATION DENSITY <br /> Appx. No. People per sq. mi. / ✓" <br />