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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers 1 Connection necessary: Yes _ No ' <br /> Does existing septic system comply with Ord. #549: Yes _ No _ Unknown _ <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> r <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No. _ Is well proper: Yes _ fdo <br /> State deficiency: <br /> Does existing or proposed use make this well public water: Yes _ No G� <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 _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: - <br /> !�. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO LLU TION PO TEN TIAL <br /> State possible burning or processing pollutants & necessary control:M�}1,.� <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed _: P` <br /> 7. PREVIOUS OPERATION HISTORY <br /> i' <br /> b. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. rnfaP,0Q _g2„!4 OL-S, ( __ <br />