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1. SEWAGE <br /> Distance to Public Sewers <br /> Does existing septic Yes <br /> Connection necessary: i , No + <br /> system comply If no, explain: P Y with Ord. X1549: yes. ` No _ Unknown <br /> Describe septic installation to be installed: <br /> T <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes .•-• <br /> No Is well proper: Yes <br /> State deficiency: No <br /> Does existing or proposed use make this well public water: Yes <br /> Sample of well water taken: Yes No No <br /> Date Taken Results <br /> Additional information or comments: <br /> 3• GARDAGE & REFUSE <br /> Licensed scavenger. pick-up: Yes No Service Area No. <br /> Other` "posed disposal method: <br /> Potential ,,problem: <br /> Lt. FLY MoSQUIT'O..OR VECTOR. POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. TOILET/BATH FACILITIES <br /> No. & location existing: ' <br /> Additional facilities needed <br /> 7. PREVIOUS OPERATION IIISMRY , <br /> d. GE14mRAL SANITATION <br /> State any problems not previously noted: <br /> 9. POPULATION DENSITY <br /> APpx• No. People per sq. mi. <br /> may. � <br />