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1. SEWAGE <br /> Distance to Public Sewers <br /> Does existing septic system cConnection necessary: iYes No <br /> omply with Ord. #,;,)49: Yes. ` No _ Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No _ Is well proper: <br /> State deficiency: Yes No <br /> Does existing or proposed use make this well public water: Yes <br /> No <br /> Sample of well water taken: <br /> Yes ..__ No ..__ Date Taken Resultit <br /> s <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No <br /> Service Area No. <br /> Other proposed disposal method; <br /> Potential problem: . <br /> fit. FLY MOSQUIM OR VECIUR POTENTIAL <br /> State possible vectorpotential & necessary control: <br /> 5• AIR POLLUTION POMITIAL <br /> State possible burning or processing pollutants & necessary control: . <br /> 6. mIL.ET BATT{ FACILITIMS <br /> No. & locution existing: <br /> 7. PREVIOUS OPERATION HI <br /> SIURyAdditional facilities needed <br /> r <br /> o• GE147RAL SANITATIOIJ <br /> State any problems not previously noted: <br /> 9. FOPULATIO14 DENSITY <br /> APpx• iJo. People per sq. mi. <br />