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(2) <br /> Distance to Vublic Sewers <br /> Does existing p y r1o�_Connection necessary: Yes (�o <br /> ng se tit/ <br /> cs stem comply with Ord . � 1,9: Yes <br /> If no, explain: _j., Bto Unknown <br /> t` a G jkk -eI1i(1 7LL 3 7 <br /> Uescribe septic installation to be installod: 7� <br /> Additional information or comments: ice! , <br /> "cu- Prppo S""4 div 's r'on <br /> 2. WATER SUI-FLY 4 <br /> Is wa.ter supplied by private well: Yes ✓ <br /> leo Is well proper: Yes `�No <br /> State deficiency: _ _ <br /> Does existing or proposed use make this, well <br /> public <br /> Sample of well water taken: Yes _ Uo �� DateTakenter: Yes ` _ <br /> - ResultIt s <br /> Additional information or comments: <br /> 3. GARBAGE & MPUSE <br /> Licensed scavenger pick-up: Yes - No _ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY MOSQUITO OR. VECTOR 1-OMiTIAL <br /> State possible vector potential & necessary control: /VIA <br /> 5• A.I R PO LLU TION PO TL U TI A L <br /> State possible burning or processing pollutants & necessary control: <br /> N� <br /> 6. YOILET/BATH FACILITIES <br /> Igo. & IOca Lion existing: _ ��/ <br /> Additional facilities rieedc;a <br /> 7 . iitEvJOUS UI'i rtA'fIOIJ HISYUItY <br /> b• GE14ERAL jAWITATIOIJ <br /> State any problems Trot prt viuu ;ly <br /> 9. FONU1A'rIUt4 DENSITY <br /> Appx. iJo . People per sq. rni . <br />