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1. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: _Yes Nol <br /> Does. existing septic system: comply with Ord. rf549: Yes No Unknown <br /> u -no; 'ezp1.sin:- - _ — — <br /> Describe septic installation to be installed: �u or IgG, <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> IO-vatet• supplied by private well: Yes NO Is well proper: Yes No <br /> S.t�te �d`eficiency: ' -e-- <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 /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. -FLY;' MOSQUITO OR HECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POMITIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. , TOILET/BATH FACILITIES . <br /> No, & -location existing: U opt. Additional facilities needed <br /> 7. ?RGVIOUS 01'LhATION HISTORY <br /> 8. (04ERAL SANITATION <br /> State any problems not previously no;:cd: <br /> 9. POPULATION DENSITY <br /> Appx. No. People per sq. mi: <br />