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1. :;a1�1A0E (7) <br /> Distance to "ublic Sewers <br /> Does axis i Connect+on necessary: Yea No <br /> nr septio gstaa oT with Ord. 1549: Yes No Unknown <br /> It ho, :aXplsia:'• — <br /> Describe adptic installation to be installed: <br /> Additional intorwtioa or comments: ..._...._. <br /> ?. WATER'SUPFLY <br /> I4 water supplied_.by private well: Yea t!o Ia well proper: Yee NO <br /> State deticiehcy: -*- <br /> Does existing or proposed use Rake this well public water: Yea <br /> Sample of well water taken: Yes _ No Date Taken Results .. <br /> Additiotul information or comments: - -- -- - <br /> 3. GARBAGE & RMSE _ <br /> LicenseC scaveryger pick-up: Yes _ No 'Service Area No. <br /> other proposed disposal method: <br /> Potential problem: <br /> 4• FLT, 110SQUIM OR 1fECMR FOMTIAL <br /> State possible vector potential do necessary control: <br /> S. AIR 110LLUTIG:; i'OTi11T1A1, i <br /> -)Late possiu_e bunting or proce:.�in6 l,ulluLanLs 6 necessary control: <br /> 6. 1UILET/BATII FACILITIES <br /> No. & location axisting: Additional facilities needed <br /> T. i'f�iVIUU ; ;'fI01J 111L;T, (Y <br /> b. GENERAL <br /> ;)La Lu atV 1,roblems rwt �,reviou�ly nu;. .i : <br /> POPULATION DENSITY <br /> Appx. 14o. People per sq. n4j . <br />