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1. SEWAGE (2) <br /> Distance to Public Sewers flAconnection necessary: Yes No <br /> Does existing septic systei comply with Ord. #549: Yes No Unknown <br /> Itno) explain: <br /> i <br /> Describe septic installation nstalled: <br /> Additional tin or co entss <br /> . WA SUP <br /> Is water supplied b prix to : Yes No Is ll proper: Yes No <br /> State deficiency: <br /> Does existing or propo, use make this well public water: Yes 40 <br /> Sample of well water take ;: Yes No vloDate Taken Results <br /> Additional information o comments: <br /> 3. 2aEMGE &;REFUSE <br /> Licensed scavenger pack-up: Yes No Service Area No. <br /> Other proposed disposalmethod: <br /> Potential problem: <br /> 4. FLY, YOSQUITO OR C PO TIAL <br /> State possibl'avector potential & necessarycon l: <br /> 5. AIR POLLUTION PommAL <br /> State sible burning or processing pollutants & necessary control <br /> 6 'MILFTLBATHFACILITIES <br /> No. & location existing: Additional facilities needed <br /> . P OUS OP ON HISTORY <br /> MiERAL SANITATION , <br /> State any problems not previouslynoted: <br /> . POPUIATIOND SI <br /> Appx. No. People per sq. mi. <br /> ESI 06 06 3/71 <br /> s r <br /> 4/74 750 <br /> AMILra <br />