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1. SEWAGE <br /> 1 <br /> Distance to Public Sewers <br /> Does existingseptic Connection necessary: iYos No <br /> A sY.,tem comply with Ord. #'49: Yes• ._._ No Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: <br /> State deficiency: oy, �� Yes No Ts well proper: Yes No ...� <br /> �J // ✓ .r",c ✓'F�.Cf 44'dF? <br /> Does existing arpro ���`� �' Fq •J <br /> posed use make this well publie�' ater: <br /> ample of well water taken: yes No <br /> SF.s r <br /> tlo � Date Taken Results` <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes <br /> Other proposed dis NO — Service Area No. <br /> disposal method: <br /> Potential problem: <br /> 4. FLY MOSQUIM OR VEC7UR POIMTIAL <br /> State possible vector potential & necessary control: <br /> 5• ATR POLLUTION POM. 171AL <br /> Stats possible burning or processing pollutants & necessary control: <br /> 6. 7UILET DA71i FACILITI S <br /> No' & location existing: <br /> 7• PREVIOUS OPERATION 1{IS7U4Y , Additional facilities needed <br /> i <br /> �. GENERAL SANITATIO14 <br /> State anY problems not previously noted: r <br /> 9. FOPULATIO14 DENSITY <br /> AApx. iJo. People per sq. mi. ,A►�!c%�� ,G <br />