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(2) <br /> 1. SEWAGE j/,�j <br /> Distance to c,ublic ewers -� � , . Connection necessary: Yes _ No <br /> woes existing septic system comply with Ord. #519: Yes _ No _ Unknown _ <br /> ;f no, ex,-.lain: <br /> e:;cribe septic installation to be installed: <br /> ZsZ. <br /> „uditional information or comments: C_e* 1►,K: AN4;.44 0%-eaef #.v cc <br /> 2. r�ATER SUPr LY <br /> Is water supplied by private well: Yes K 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 > ate Taken Results <br /> Additional information or comments:'V4& <br /> 3. uARBAGE & kr:FUSE /( f✓d'+''` �r`OA vj � �-- <br /> Licensed scavenger pick-up: Yes _ No 2�f Service Area No. <br /> Other proposed disposal method: Gai't/wy' -'ea 5,��; r.,vr Gt.• ►�%// <br /> rotential problem: <br /> 4. FLY, MUSQUilO OR VECTOR '_�TENTIAJ <br /> r :.;tate pos ible vec or po, ,-:ntial & necessary control: <br /> 7. Al-L POLLU`ilON POTENTIAL <br /> ._ ,ate possible burning or processing pollutants & necessary control: ti/,r1 <br /> 1 Lir T/BATH FACILITIES <br /> & location existing: Additional facilities needed <br /> 7. :r VIUU:; u: EIHATIOIr H1_'MRY/ <br /> L)ttX A4- <br /> o. GEi•,EhAL SAIN ITATION <br /> State any problems not previ.,i­sly noted: <br /> 9. ; ,;: ULA TION DrNsITY <br /> ,x . iso. People per mi. �✓i'�c 't� ''`� 'f�y �i�I'� l�` <br /> :i iib ,Gb 371 4/74 750 <br />