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1. SEWAGE w` �,i[c� �.Q .c-iQ / //a�z-r(2) t S lvc-LTPcl <br />Distance to Public sewers C6nnection necessary: Yes P --,No <br />Does existing septic system comply with Ord. #519: .Yee No Unknown <br />If no, explain: -- <br />Describe septic installation to be installed: <br />Additional information or comments: <br />A - - - <br />2. <br />WATER SUPPL'If <br />Is water supplied by private well: Yes _ <br />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 <br />_ <br />Date Taken Results <br />_ <br />Additional information or <br />comments:27 <br />3. <br />GARBAGE &, REbija <br />Licensed scavenger pick-up: Yes _ No <br />Service Area No. <br />Other proposed disposal method:^n <br />�� 4 fl <br />Potential problem: <br />4. <br />FLY, NOSQUIR) OR VECTOR F02ENTIAL <br />State possible vector potential & necessary <br />control: <br />- - <br />5. <br />AIR POLLUTION POTEIJTIAL <br />State possible burning or processing pollutants & necessary control: <br />6. <br />TOILET/BATH FACILITIES <br />No. & location existing: <br />Additional facilities needed <br />7. <br />PREVIOUS OPERATION HISTORY <br />64 ✓' <br />Ir a- <br />d. <br />GEIERAL SANITATION <br />State any problems not previc _2.y noted: <br />9. <br />POPULATION DENSITY <br />Appx. No. People per so <br />dH o6 03 , 3/71 <br />4/74 750 <br />