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. (2) <br />1. SEWAGE <br />Distance to Public Sewers 200 1 Connection necessary: Yes No <br />Does existing septic system comply with Ord. 4549: Yes — No _ Unknown <br />If no, explain: <br />Describe septic installation to be installed: <br />Additional information or commdfits: <br />.4- <br />E <br />2. WATER SUPPLY <br />Is water supplied by private well: Yes No ''Is well proper: Yes _ No _ <br />State deficiency: <br />Does existing or proposed use make this well public water: Yes _ No <br />Sample of well water taken: Yes No _ Date Taken Results <br />Additional information or comments: " d- <br />3. GARBAGE & REFUSE `5" G�ti' a/-c%� n u t IY <br />Licensed scavenger pick-up: Yes _� No _ Service Area No. <br />Other proposed disposal method: <br />Potential problem: <br />4. FLY, MOSQUITO OR VECTOR POTENTIAL <br />State possible vector potential & necessary control: /Z'/?) � <br />$. AIR POLLUTION POTENTIAL <br />State possible burning or processing pollutants & necessary control: <br />b. TOILET/BATH FACILITIES <br />No. & location existing: <br />7 <br />Additional facilities needed <br />8. GENERAL SANITATION <br />State any problems not previously noted:o, <br />9. POPULATION DENSITY <br />Appx. No. People per sq. mi. _A,�ej <br />