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(2) <br /> 1. SEWAGE <br /> Distance to Public Sewers Connection necessary: .-Yes No <br /> Does. existing septic system: comply with Ord. J549: Yes _ No _ Unknown <br /> Descr septi installation to be installed: / - o <br /> Additional--inforwtion or comments: - <br /> 2. WATER SUPPLY <br /> I Afttei'�gugpliedby private wells Yes NO Is well proper: Yea No <br /> Sa to .46 iciency: �_ �,�I .��.. � 17 <br /> Does existing or proposed use make this xell.public water: Yes ✓No -� <br /> Sample of well water taken: Yes No Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE do RJJ SE - <br /> Licensed~scavenger pick- up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. =, `MSQUITO 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. ZOILET/BAT' FACILITIES <br /> No. &-location existing: v� Additional facilities needed <br /> 7. ?RE:VIOUS Ol'MATION HISTORY <br /> i' ` - - - <br /> 8. GEIv"ERAL SANITATION <br /> State any problems not previously not:cd: <br /> 9. POPULATION DENSITY 7 <br /> .,.Appx.;.No. People per sq. ml. <br />