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1. SEWAGE <br /> (2) <br /> Distance to Vubllc Sewers Connection necessary: Yes _ No \ <br /> Does exia¢ing septic system o—o—mpry with Ord. d549: Yea No Unknown <br /> If iso, explain:.'.... <br /> Describe naptic installation to be installed: <br /> Additional information or comaments: <br /> 2. WATER SUPFLY <br /> Iq water supplied by private well: Yes Ho _ Is well proper: Yes No _ <br /> S,t*te 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. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR I-01ENTIAL <br /> State possible vector potential Lc necessary control: <br /> 5. A-IR POLLUTIG:; i 07EIITIAL . <br /> :tate possio_e ourninp; or procus;,in6 puliuLanLs & necessary control: <br /> 6. TUILEVRATN FACILITIES <br /> ho. & location existing: Additional facilities needed <br /> 7. 11h.EVIOU:; UI _�'rION HI:�'[LI(y <br /> b. alv'~:RAL SANITATION <br /> StaLu arty problems not p,ruviou;;ly nu ., ,i : <br /> 9. POPULATION DENSITY <br /> Appx. No. F,eople per sq. mi. <br />