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�' <br /> 1, SEWAGE A/ (2) <br /> h�� 2)h�� S <br /> Distance to Public Sewers A(e?-�r Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549: Yes No Unknown <br /> If no, explain: i <br /> Describe septic installation to be installed: -,/, <br /> 1 <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is well proper: Yes _ No _ <br /> State def;^;ency: <br /> 'Does existing or proposed use make this well public water: Yes G No N <br /> Sample of well water taken: Yes _ No _ Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> U-1307) N5 J3eF <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 c <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 'TOILET/RATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> b, GENERAL SANITATION <br /> State any- problems not previously noted: <br /> 9• POPULATION DENSITY <br /> Appx. No. People per sq, mi, <br /> I <br />