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I. SEWAGE N /' (2) <br /> Distance to Public Sewers Connection necessary: Yes No -elk's �,...,. <br /> Does existing septic system comply with Ord. #549: .Yes �(_ No —' Unknown <br /> If no, explain: <br /> Describe septic installation to be installed: a!Q fz �, r <br /> u,(i.rL Ve 4t�►; '"� o �l�Ot O tt . iT� <br /> Additional information or 'comments: S ` <br /> �4�`'c sv•<"r ate,, r car �/3 i3 <br /> �a: q <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ No ZIs well proper: Yes _ No <br /> State deficiency: glpzc, ,tAe(_ <br /> Does existing; or proposed use make this well public water: Yes No A)0 f S",&` <br /> -- c,,C %s wctP <br /> Sample of well water taken: Yes _ No Date Taken Results <br /> Additional information or comments: V(, ;sAe <br /> 3. GARBAGE &,REFUSE lz , /1l, <br /> ff.'s�,r•.- <br /> Licensed scavenger pick-up: YesNo Service Area No. <br /> Other proposed disposal m-:thod: ac__ di � Vie; /;I ,• Ae <br /> Potential problem: 6, <br /> 4. FLY, moSQUITO ORyEcUR �', ,j TIAL <br /> State possible vector potential & necessary control: <br /> S. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. ZOILEVRATH FACILITIES <br /> No. & location existing: Additional facilites needed _ <br /> 7. PREVIOUS OPERATION HISTORY <br /> Cl�fif �a/,Lir�C i /.t��u r?�sr ( �tr� <br /> 'l-4"no-o0-e- utid�c��,c,.r", Sce teff iti ��//�C mor ;rl�r_� <br /> 8. GEhERAL SANITATION <br /> State any problems not previoi a1y noted: <br /> 9. POPULATION DENSITY / <br /> Appx. No. People per sq mi Q IJ e lr;cam (i��,.P.� vt."`' �ra►��t �:Cs�'e � < <br /> S;,/e ow 1W* <i/7'0 �e1 <br /> EH 06 06 3/71 4/74 750 <br />