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(2) <br /> 1. SEWAGE ' <br /> Distance to Public Sewers t 15M1 Connection necessary: Yes _ No <br /> Does existing septic system: comply with Ord. 4549: Yes "o Unknown <br /> Describe septic installation, t be installed: <br /> Additional infornati n or comments: <br /> 2. WATER SUPPLY <br /> Iq,`water supplied by private well: Yes L-1I4o Is well proper: Yes No <br /> State deficiency: L- <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes No I,—'Date Taken <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE y , <br /> Licensed scavenger pick-up: Yes L---N—o _ Service Area No. <br /> Other proposed disposal method: s-- V-D(�� <br /> Potential problem: <br /> 4. M,' MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector pot ntial & necessary control: Y-" ` <br /> 5. AIR POLLUTION POMNTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES n <br /> No. & location existing: -�` rj��- Additional facilities needed <br /> 7. ?MVIOUS OPLrcA TION HISTORY <br /> 8. GE147,RAL SANITATION <br /> State any problems not previously no ud : <br /> 9. POPULATION DENSITY <br /> A No. Feo le per sq. mi. <br /> PPx P <br />