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1. SEWAGE (2) <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic sYstem comply t Ord. #549: -Yes No Unknown <br /> If o, explain: <br /> Describe septic instal atio e ifnst lle : , e �+)rr, <br /> Additional o r is <br /> 2. KATER SuppLy <br /> Is water supplied ri t well: Yes o Is well proper: Yes No <br /> State, deficiency: e 5+ f u <br /> Does is inn orproposedis ell public water: Yes No <br /> Sample f e watert es o \ Date Taken Results <br /> Additional information o s: wivy- 4zi4ed t,)esll rhoOL i <br /> 3. GARBAGE ISE_ caus a4tT _71 <br /> Licensed scavenger pick-up: Y o Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: 06l e. <br /> . LY," YUSQUITO OR VECTOR -IMAL <br /> u, <br /> State possible vector potential & necessarycontrol; <br /> B <br /> AIR POLLUTION POTE14TIAL <br /> State possible burning or processing pollutantscess control: <br /> r't.5-f r oc fp l y►'( ® — e1C15 7 tPg/t t'd C)f"1�' d 1 <br /> 6. MLLET EAILI anti <br /> No. & location existing: <br /> ii A ditio l f ties ill <br /> -PREVIOUS OPERATION HISTORY <br /> i� �� U c � <br /> C, <br /> GEhERAL SANITATION , <br /> State any problems not previc) noted: L,) a�`. ��J/ J' �1�0�e- or <br /> POPULATION DENSITY <br /> Appx. No. People per so <br /> t ultw <br /> * 063171 /? 750 <br />