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1. SEWAGE <br /> Distance to Public Sewers Connection necessary: iYes _ No <br /> Does existing septic system comply with Ord. Ni49: yes. No Unknown <br /> If no, explain: --- -- — <br /> Describe septic installation to be installed: <br /> Additional information or comments: /V 77 77, 77 <br /> 7 <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes No Is we11 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 _ Date Taken Results <br /> Additional information or comments: e S�,i p hcad p f —� <br /> �//P//i y <br /> 3. GARBAGE & REFUSE„ /- r e p <br /> Licensed scavenger pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method; ; <br /> 4. "'LY, NjSWULU OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: - <br /> S• AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/DATE{ FACILITIES <br /> No. & location existing: Additional facilities needed <br /> 7• PREVIOUS OPERATION NISTORY <br /> d. GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> Appx, No, People per sq, mi. <br />