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1. SL14AGE <br />(2) <br />Distance to Public Sewers Connection necessary: Yes_ No <br />Does existing septic system comply with Ord. #549: Yes No Unknown <br />If no, explain: <br />Describe septic installation to be installed: <br />Additional information or comments: <br />2. <br />WATER SUPPLY <br />Is water supplied by private well: <br />State deficiency: <br />Yes _ <br />No _ Is well proper: Yes _ No <br />Does existing or proposed use make <br />this well public water: Yes No <br />Sample of well water taken: Yes <br />No ✓ <br />_ _ <br />Date Taken Results --7� <br />Additional information or ccents:p <br />ay <br />3. <br />GARBAGE &, REFUSE j` c c a e� c� <br />Licensed scavenger pick-up: Yes _ <br />No <br />Service Area No. <br />Other proposed disposal method: <br />_ <br />Potential problem: <br />4. <br />FLY, MOSQUITO OR VECTOR POTENTIAL <br />State possible vector potential & necessary <br />control: ,r cc <br />_A/m <br />5. AIR POLLUTION POTENTIAL <br />State possible burning or processing pollutants & necessary control:, lyb <br />6. <br />No. & location existing: Additional facilities needed <br />7. <br />8. GENERAL SANITATION <br />State any problems not previously noted: <br />9. POPULATION DENSITY <br />Appx. No. People per sq, mi. <br />EH 06 06 <br />)I - #1• <br />3/71 <br />4/74 750 <br />