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(2) <br />1. SEWAGE <br />Distance to Public Sewers -, Connection necessary: Yes _ No <br />Does existing septic system comply with Ord. #549: Yes No Unknown <br />IP no, explain:'..._ <br />Describe septic installation to be installed: <br />Additional information or comments: <br />r <br />2. WATER SUPPLY <br />I@'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 x <br />Sample of well water taken: Yes _ No Date Taken Results <br />Additional information or comments: -j%,Aiy ° " < _ , ii -i ✓ ij' ✓� , Q��i�j <br />3. GARBAGE & REFUSE <br />Licensed scavenger pick-up: Yes No Service Area No. <br />4. <br />Other proposed disposal method: <br />Potential problem: <br />FLY, MOSQUITO OR VECTOR POTENTIAL <br />State possible vector potential & necessary control: <br />5. AIR POLLUTION POTENTIAL <br />State possible burning or processing pollutants & necessary control: <br />6. TOILET BATH FACILITIES <br />No. & location existing: �� Additional facilities needed <br />7. 'REVIOUS 01•ERATION HISTORY <br />,' Cid ; , . , o; i , .✓ i i' J <br />8, GENERAL SANITATION <br />State any problems not previously no; d: <br />9. POPULATION DENSITY <br />Appx. No. People per sq. mi. <br />