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l. 'At,WAOE (7) <br /> Distance to :•ublic Sewers Connecti <br /> Does exia¢ing Septic MySt11�—With Ord. J549: <br /> necessary; Xaa / No <br /> It ims ez laia:" r �ti49: Xea No Unkno m <br /> Describe septic installation to be installed: <br /> Additional lnforMation or oosraents: <br /> 2- WATER SUPFLY' <br /> Ip water supplied by 'prtyate well: Yep EJo <br /> tency: Ie well proper: YNo <br /> Sate defici - A ea -�- <br /> Door existing or proposed use :Hake this well public water: Yea No <br /> Saiaple of well water taken: Yrs _ No _ <br /> •- . Date Taken Results <br /> Additional information or co:oments: <br /> j. GARB ME & REFUSE <br /> Licensedacavervger pick-up: Yes _ No 'Service Area No. <br /> Other proposed disposal method- <br /> Potential problem: <br /> 4- I''LT2 lospUI10 OR VErinR MUNTIAL _ _ .- <br /> State Po931ble vector potential & necessary control: <br /> S. AIR IOLLUTIG;; P07c: 1TIAI. , <br /> �LaLe Posslocc burning or Nroces;;ln6 I,ullutants necessary control: <br /> 6- TUILET/BATH FACILITIES <br /> ho. & location existing: Additional faculties needed <br /> 7. i'hc;Vluu:; Ut ..r,014 II1:J 1',,(y <br /> b- Gl':I,ERA L :iAl-i iA TIou <br /> :;Lata arty problem:] nut 1,1'ev►ou�ly <br /> POPULATION DENSITY <br /> APPx - No. People per sq. n,i . <br />