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1. SEWAGE (2) •. <br />Distance to Public Sewers Connection necessary: Yes _ No . <br />Does existing septic system comply with Ord. #549: Yes No Unknown "r <br />If no, explain: <br />septiQc installation to be installed: f=&42:3 zdA�ta J`jf 0 ze /, " <br />_Arla� 641V /) "D. i__ ".A, <br />Additional information or comments: <br />2. WATER SUPPLY. a.,,V -to'C% r <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: Yy i d a S 22 sP �a�d b/ P /ic/2 iGli <br />3. GARBAGE & REFUSE 5`` ` &"' �" R--e�, T <br />Licensed scavenger pick-up: Yes _ No Service Area No. <br />Other proposed disposalmethod: .0 jr) ort A -e ✓h z'r-_-P <br />Paien lem: <br />4. FLY, MOSQUITO OR VECTOR POTENTIAL <br />State possible vector potential & necessary control: `i <br />0—/ _ I/_' : .o 6 1 n / fl '/ . /1 _ <br />5. AIR POLLUTION POTENTIAL <br />State possible burning or processing pollutants & neces <br />b. TOILET/BATH FACILITIES <br />No. & location existing: <br />7. PREVIOUS OPERATION HISTO <br />control: Z/ <br />Additional facilities needed <br />8. GE14ERAL SANITATION <br />State any problems not previously n ted: �p <br />9. POPULATION DENSITY <br />9'1 2_ <br />PiS%`AC� <br />