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( 2) <br /> Distance to ?ublic Sewers Connection necessary: Yes 1�0 <br /> Does existing septic system comply with Ord. #5h9: Yes No Unknown <br /> I£ no, explain: <br /> Describe septic installation to be installed: Cp <br /> Add hien or comzaen s: <br /> 2. WATER SUPPLY /�3(►, — %�1,.Gtit� 5;;0'61'e-* <br /> Is Water supplied by private well: Yes tIs well proper: Yes L- No/ <br /> Does existing or proposed use make this well public water: Yes _ No. _ <br /> Sample of well water taken: Yes _ NoL----Date Taken Results <br /> i <br /> Additional information or comments: 7"/ -e <br /> 3. GARBAGE & REFUSE ; 'd P w i G!� (,v� S s ez /s c <br /> -T� �� f eL �i��i <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> - <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 /> J-' <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing- Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY r <br /> v. GEIdERAL SANITATION <br /> State any problems not previously noted : <br /> 9. 1OPULATION DENSITY <br /> Appx. No . People per sq. mi . <br />