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BEWAGE <br /> Distance to Public Sewers _ Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes Nor, ._. <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied. b:7 private well: Yes 1110Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No - Sample of well water taken: Yes No Date taken _ <br /> Results Additional information or comments ✓" <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick--up: Yes No Service Area No .� <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELX. -MOSOUITQ OR rM-0 PSi'EENTIAL <br /> State possible vector potentiftl necessary control : <br /> 5. ZQjj.FT/BATH FAriLjTES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . 'EREIIQU Qj!ERATT0N HISIQRX <br /> T . GENERAL SAT]IT_4TTON <br /> State ariy problems not previously rioted: <br /> 8 . pnPULATI0N -DEHSTjv <br /> APPx. No. People per sq. mi, . <br />