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1. SEVAGE <br /> Distance to Public Sewers �'/�4�r/,.Eor►nectionnecessary: ' Yes No <br /> Does existing septic system co—mp-1 with Ord. #"49: Yes• N <br /> Il no, explain: o Unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2• TEIt SUPPLY <br /> Is Water supplied by private well: Yes .• <br /> State dericiency: ,off �� No Is well proper:' Yes No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample or well water taken: yes No ,. <br /> tJo Date Taken Results <br /> Additional information or comments: ------ <br /> 3. GARDAGE & REFUSE <br /> Licensed scavenger. pick-up: Yes <br /> Other proposed disposal method: No --" Service Area No. <br /> Potential problem: <br /> fit. FLY MOSQUIM OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5• AIR POLLUTION PO2ENTIAL <br /> State possible burning or processing pollutants & necessary control; <br /> 6. mILET BAT!{ FACILITIES <br /> No. & locution existing: _iy� ' <br /> 7. PREv1OUS- OPERA1"�. ON ILISTuItY' , Additional facilities needed { <br /> 8. GEUE RAL SANITATIO11 <br /> State any problems not previously noted: <br /> 9. POPULATIO14 DENSITY <br /> Appx• 110. People per sq. mi, <br />