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1. sEWpGE (2) <br /> Distance to Public Sewers Connection necessary: Yes No, ' <br /> Does existing septic systemcomply with Ord. #549: Yes — No _ Unknown — <br /> If no, explain: yz �/ <br /> Describe septic installation to be installed: c, L� ' <br /> Additi/final information oorcomments: ,� tea/ yn�iyl,� gyres �— <br /> �/lilx— .¢irs" <br /> 2. WATAR SUPPL <br /> Is water supplied by private well: Yes L- ,%o Is well proper: Yes 140 <br /> State deficiency: 77 <br /> Does existing or proposed use make this well public water: Yes — No — <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 /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL / <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: - <br /> b. TOILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> S. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br />