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1. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: Yes _ No 'V- <br /> Does <br /> V <br /> Does existing septic system comply with Ord. #549: 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: Yes No Is well proper: Yes _ No _ <br /> State deficiency: <br /> i <br /> Does existing or proposed use make this well public water: Yes No ti <br /> Sample of well water taken: Yes _ No - . - Date Taken Results+ <br /> Additional information or comments: <br /> 3. GARBAGE &;REFUSE <br /> Licensed scavenger pick-up: Yes , No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: A�- <br /> 5. AIR POLLU TIOtd PO TE14 TIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TDILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7. PREVIOUS OPERATION HISTORY <br /> 8. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi. <br /> EH 06 o6 3/71 <br /> a/74 750 <br />