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1. SEWAGE . <br /> Distance to 'Public Sowers v <br /> Does existing septic Connection noeessary: iyos No <br /> Il no, explain: s}'ste11 comply with Ord. #'49: yes. No ' Unknown <br /> Describe septic installation to be installed: <br /> Additional inrormation or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private wall: Yes • <br /> State deficiency: NO --- Is wol], proper: Yes .�• <br /> No <br /> Does existing or proposed use make this Well public water: Ye <br /> Sample of well water taken: yes s No <br /> -- t10 .___ Date Taken _ •- <br /> Additional information or comments: Results <br /> 3. GMMAGE & REFUSE --__ <br /> Licensed scavenger. pick-up: <br /> Other proposed disposalYew <br /> method: No Service Area No. <br /> Potential problem: . <br /> �. FLY MOSQUITO OR VECTOR POMTIAL <br /> State possible vector potential & necossary control: <br /> 5• AIR PO LLU TION POM. 4 TILL <br /> State possible burning or processing pollutant,, & necessary control: <br /> 6. TOILET J3A71i FACILITIE <br /> No. & location existing: <br /> 7• PREVIOUS, OPERATION 1{ISTORY Additional facilities needed <br /> --� f <br /> d. GrHE RAL SANITATIOII <br /> State any problems not previously noted: <br /> ------------ <br /> 9. POPULATION DENSITY <br /> APpx• 140. People per sq. mi. <br />