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2 jEWAGE { <br /> Distance to i'ublic Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. d'5,ig: Yes No Unknown <br /> If no, explain: _ <br /> llesc ibe septic install ion to be installed: <br /> �_ <br /> 1577 , <br /> ~fie <br /> Additional information or comments: — <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No _ Is well proper: Yes _ No _✓ <br /> State 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: r✓QyiA f 6 65,111 <br /> 3. GARBAGE & R>;1U SE /9-c-t-s,v /;7 r sT� <br /> Licensed scavenger pick-up: Yes L-,No _ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR. VECTOR lOTENTIAL <br /> State possible vector potential & necessary control: �— <br /> 5• A>R POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. 'IDILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. ,'REVIOUS Ul'LhATIO14 HI5'l01tY <br /> b. GE14"ERAL SANITATION <br /> State any problems not previously not...J : <br /> 9. FOPULATIO14 DENSITY <br /> Appx. No. People per sq. mi. <br />