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(2) <br />1. SEWAGE <br />Distance to i'ublic Sewers <� Connection necessary: Yes /No <br />Does existing septic system comply with Ord. #5'49: Yes _ No _ Unknown <br />If no, explain: <br />Describe septic installation to be installed: <br />Additional information or comments: <br />2. WATER SUPPLY <br />A <br />Is water supplied by private well: Yes _ No ✓_ Is well proper: Yes _ No _ <br />State deficiency: <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.c�z �eYt <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 />6. TOILET/BATH FACILITIES <br />No. & location existing: Additional facilities needed <br />7. ehEVIOUS OPLitATION 'HISTORY <br />8. GENERAL SANITATION <br />State any problems not previously noted <br />9. POPULATION DENSITY <br />Appx. No. People per sq. mi. <br />