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• 0I <br /> 1. :;r.'WAUE (2) <br /> Distance to i'ublic Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. d5it9: Yes NUnknown <br /> If no, explain: — — — <br /> Uescribe septic installation to be installrad: <br /> Additional information or coaaments: <br /> 2. WATER SUPPLY <br /> Is water supplied by private well: Yes _ leo �is well proper: Yes Ho <br /> State deficiency: —" <br /> Does existing or proposed use make this well public water: Yes No <br /> Sample of well water taken: Yes — 140 _ Date Taken _ Results` <br /> Additional information or comments: C t) } /c <br /> 3. GARBAGE & mnSE <br /> Licensed scavenger pick-up: Yes _ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> b. FLY, MOSQUIM OR. VECMR I.OnN IAL <br /> State possible vector potential & necessary control: j�t'�'� <br /> f <br /> 5. AIR POLLUTION POTMITIAL <br /> State possible burning or processing pollutants & necessary control: f�h� <br /> 6. 'WILET/BATH FACILITIES <br /> bo. & location existing: Additional facilities needed _ <br /> 7. LhEVIOU5 01'LitATIO14 HIS'i01tY <br /> b. GE1vERAL SANITATIou <br /> State any problems not prUviou;;ly" ono L, J: <br /> 9. FOPULA'PION DENSITY <br /> Appx. No. People per sq. mi. <br />