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1• OWAUt (?) <br /> Distance to "ublio Sewers Connection neceaeary: Yes _ No <br /> Does exisyirg aeptio gstea ooTwith Ord. ,���9: Yea No U <br /> if ho, �ezplainf. — — <br /> Ueacribe septic installation to be installed: <br /> Additional inform tion or comments: <br /> 2. WAR SUPFLY <br /> Iq 'vatee, supplied by private well: Yep ` ' t!o <br /> • �.L Is well proper: Yee NO <br /> St4te deficiency: <br /> Does exiat_ing or proposed use make this well public water: Yea <br /> Saatple of well water take � '}"'. -' `^ <br /> n: Xes _ No � Date Taken Results <br /> Additional information or comments: .��'v: - •- - <br /> 3. GARBAGE Jk R>•:FusE <br /> Licensed-scave _...w_ <br /> �er pick-up: Yes ho 'Service Area No. <br /> Other. proposed disposal method- <br /> Potential <br /> ethod:Potential problem: <br /> MOSQUITO OR VECMR I-OUNTIAL <br /> State possible vector potential do necessary control: <br /> S. AIR 11OLLIJTIG:: i'OTcl11'ltil. 1 <br /> Late pOYsIu-e burnln • or <br /> L proccsslu6 I,ulluLan ts & necessary control: 1 <br /> 6. 1UILET/LIAT1i FACILITIES <br /> ho- location existing: Additional ractlitie3 needed <br /> 7. �'hiViUU ; 'fI01� IliL;T,I(Y <br /> b. GENERAL iAl�i'i A TIU1J <br /> :i La Lu et�y problems nuL jxcviou:,ly ne:, .i : <br /> POPULATION DENSITY <br /> Appx . iso. People per sq. mi . <br />