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� . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> _ If�' I f no, explain: <br /> xplain: <br /> -C"/ <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes iso Is well proper: <br /> es No State deficiency: <br /> oes existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> exults Additional inforrratior� ar carri�ierxts <br /> 3 . GAB ACE & REFUSE <br /> . Lice.nsed' seavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. U1, MOS6111110 t7R V { fir <br /> Stat6 passible vector potential. necessary control ! <br /> 5 . <br /> No. & location existing: Additional <br /> facilities needed- <br /> 6 . <br /> eeded6 . PREY1 US OPER TTON T4=-QRY <br /> 7 . GENBRAI, S IA <br /> State any problems not previously noted:- <br /> 8 . <br /> ioted:,_._.8 . P_OPU1.6Tj9N DENSITY <br /> Appx. No. People per sq. mi . <br />