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1. SEWAGE <br /> Distance to Public Sewers <br /> Connection necessary: } Yes No <br /> Does existing septic <br /> If no, explain: system comply with Ord. l/�49: Yes. ._ No unknown <br /> Describe septic installation to be installed: <br /> Additional information or comments: <br /> 2. WATER SUPPLY <br /> Is water supplied by privato well: <br /> Yes peri Yes N <br /> State deficiency: �; No Is well pro <br /> �'qny �,, o <br /> Does existing or proposed use make this well public water: Yes i <br /> Sample of well water taken: Yes ` 110 ` No <br /> _„ Date Taken Results <br /> Additional information or comments: <br /> 3. GARBAGE & REFUSE �'//'1 s%`f�o/o1F✓ o �s✓ldC)G��✓E•Cl <br /> Licensed scavenger pick-up: Yes No <br /> Other proposed dis Service /area No. <br /> posal method: <br /> Potential problem: <br /> 4. FLY MOSQUIM OR VE212H POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5• AIR POLLUTION POTENTIAL <br /> State possible burning or processing pollutants & necessary control: <br /> 6. mi[LET/BATH FACILITIES <br /> NO- & location existing: <br /> ?• PREVIOUS OPERATION I{ISIURY , Additional facilities needed <br /> r <br /> o. GE147CRAL SANITATIO11 <br /> State any problems not previously noted: r <br /> 9. FOPUI.ATIO14 DENSITY <br /> APpx. 140. People per sq. mi. <br />