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1. :;EWAUE (2) <br /> Distance to I•ublie Sewers Connection necessary: Yea _ No <br /> Does exis�ing septic system—with Ord. d549: Yea No Unknown <br /> If io, :e`xPlsia:' _ _ <br /> Describe sdptic installation to be installed: <br /> Additional lnformtion or cownente: <br /> 2. WAR.SUPFLY.,... <br /> Ip water suNPlied.. by private well: Yes _ tJo Ie well proper: Tee No <br /> Situs deficiency: _ �- — <br /> Dose existing or proposed use make this well public water: Yee _ No <br /> Sample of well water taken: Yes _ No Date Taken _ Rssults~ <br /> Additional information or comments: <br /> 3. GARBAGE & RMSE <br /> Licensed_ acavegger pick-up: Yes _ No 'Service Area No. <br /> Other proposed disposal method: <br /> Fotential problem: <br /> 4• <br /> FLT, moSQUIIU OR VECMR WMTIAL -- - -- <br /> State possible vector potential & necessary control: <br /> $. AIR P0LLUTIG:: 007EIIIIAI. <br /> ''tale possio_e: burninc or proces;:ln6 I,ulluLams & necessary control: <br /> 6. TUILET/t1AT}i FACILITIES <br /> NO. & location exi9ting: Additional facilities needed <br /> 7. i'h.cvjuu:; Ui <br /> GEI Ea(AL :.iAI%i iATIufI <br /> :i La Lu a,V problems 110L 1,rev iou�ly 110:. .i : <br /> POPULATION DENSITY <br /> Appx • 140. I-eople per sq, n4i . <br />