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W. <br />Distance to ?ublic Sewers Connection necessary: Yes — lao <br />Does existing septic system comply with Ord. #549: Yes No Unknown may_ <br />If no, explain: <br />M <br />Describe septic installation to be installed: <br />;�o <br />Additional information or comments: <br />2. <br />WATER SUPPLY ; . r PF <br />No <br />Is water supplied by private well: Yes <br />No Is well proper: Yes <br />State deficiency: <br />f <br />Does existing or proposed use make this <br />Well public water: Yes — No. <br />Sample of well water taken: Yes No <br />Date Taken Results <br />Additional information or comments: <br />3 <br />GARBAGE & REFUSE <br />610 <br />. <br />Licensed scavenger pick-up: Yes — No <br />Service Area No. <br />Other proposed disposal method: <br />Potential problem: <br />!3. <br />FLY, MOSQUITO OR VECTOR POTENTIAL <br />State possible vector potential & necessary <br />control: <br />�:. <br />#g <br />1k � kr <br />5 . AIR PO LLU TION PO TEN TIAL <br />MState possible burning or processing pollutants & necessary <br />Pow <br />6. 10ILET/EAgV FACILITIES <br />No. & location existing: Additional facilities needed <br />7. PREVIOUS OPERATION HISTORY <br />ztrol: <br />t�0 <br />v. GENERAL SANITATION <br />State any problems not previously noted <br />mi <br />9. I-OPULATION DENSITY <br />Appx. No. People per sq. mi. <br />