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1. OWA0E (?) <br /> Distance to Vublic Sewers �V a?,-L i <br /> Connection necessary: Yea No ! <br /> Does exis`ing aeptio system oo�y with Ord. 649: Yea _ No Unknown r <br /> Ir no, 4xplaic:" — <br /> Describe sdptic installation to be Ins lied: <br /> 0 <br /> AddLtjQnAjjaLQzmtjGG or- s: ✓e. _ . <br /> 2- A7FR SUPFLY­.... _. . . . <br /> Zq 'Water supplied.by priva to well: Yea tJo Ie sell propos ' Yea No <br /> S,4" deficiency: -*- — <br /> Dose existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: _ <br /> _ t,�•,ri; c' <br /> Yrs _ No Date Taken Results r .....' <br /> Additional information or comments: <br /> 3. GARBAGE & R1::FUSE V5;-/� , 5. <br /> _ <br /> Licensed T <br /> scavenger pick-up: Yes — No 'Service Area No. <br /> Other proposed disposal method <br /> Potential problem: <br /> 4. FLT, MOSQUIT0 OR VICTOR 1.01EZ'iTIAL -- - - <br /> - <br /> State possible vector potential (k necessary control: <br /> 5. A.Ik IOLLUTIG:: i'OTrU1'Ihl, i <br /> Late POSsio_e burnlnt: or processing 1,011uLaMs 6 necessary control: <br /> 6. TUILET/HATI! FACILITIES <br /> ho. location exi9ting: Additional factlitlea needed <br /> 7• 'ILc V1UU� UI �'fION Ii1 ;7 ,itY <br /> Ag <br /> b GE14ERAL SAl%i iATIU1J <br /> :;La Lu erk_y problems iw ,rev lou�ly nu:. .i : r <br /> POPULATION DENSITY <br /> APPx - i4o. People per sq. mi . <br /> f <br />