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Distance to i'ublic Sewers �1�' VConnection necessary: Yes IJo <br /> Does existing septic system comply with Ord. — � <br /> If no, explain: p y /1�t�9: Yes j� No Unknown _ <br /> r-a oO <br /> Uescribe septic installation to be installed: <br /> 1� <br /> Additional information or couunents: <br /> 2. WATER SU?FLY <br /> Is water plied by private well: Yes '✓ <br /> No Is well proper: Yes No <br /> State deficiency: — <br /> Does existing or proposed use make this, well POlic water: Yes <br /> Sample of well water taken: Yes _ No • <br /> ate Taken - <br /> Results <br /> Additional information or comments: <br /> 3. GARBAGE & REkIJSE <br /> Licensed scavenger (� <br /> pick-up: Yes _ No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSQUITO OR. VECTOR I-OTEMAL <br /> State possible vector potential & necessary control: <br /> 5. AIR PO L.L.0 TION PO TtiI i TI A L <br /> State possible burning or processing pollutants & necessary control: <br /> 6. LOII.GT/BATIi FACILITIES <br /> 1,0. & location existing: <br /> Additional facilities ,ieedc;� <br /> 7. ,'ItrVIOUJ UI•i;rtATIOIJ III:.i'ItMy <br /> b. GEI�ERAL SAWITATI0I4 <br /> State any, problems not p •e iou ;ly no, .. i : rAZ <br /> VJ Q_ - r c',IA <br /> v b <br /> 2J c <br /> 9. FONUL.A'rION DENSITY <br /> Appx. ido . People per sq. n:i . LO <br /> i <br /> i <br />