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q9 r f, a w x x - ' T 5 'p• .. <br /> i <br /> 7' <br /> SEWAGE ` ° <br /> k� <br /> Distance to i'ublic Sewers Connection necessary: Yes _ No <br /> Does existing septic system comply with Ord. W549: Yea No Unknown <br /> If no l 44 <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> I0 4ater supplied by private well: Yes NO Is well proper: Yes No- <br /> StA" '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: <br /> 3. GARBAGE & REFUSE <br /> U. ensed_scavenger pick-up: Yes _ No _ Service Area No. r <br /> Other proposed disposal method : <br /> Potential problem: <br /> Lt. FLY; MOSQUITO OR VECIUR 10TENTIAL n 1 <br /> State possible vector potential & necessary control: <br /> U <br /> S. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> M ILET/BATH FACILITIES <br /> No. & location existing: Additional facilities needed <br /> ?. i'REVIOUS 01'LitATION HISMItY <br /> 8. GENERAL SANITATIOid <br /> State any problems not previously no,. J : <br /> 9. POPULATION DENSITY <br /> Appx, No. People per sq, rr,i. <br />