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1 . SEWAGE <br /> Distance to Public Sewers 4 Connection necessary: Yes No <br /> Does existing septic system comply with Ord. #549 : Yes Nom <br /> Unknown If no, explain: <br /> Describe septic in tallation to be installed: <br /> 2 . WATER SUPPLY / <br /> Is water supplied by private well : Yes Na ✓ Is well proper: <br /> Yes No State deficiency: <br /> r <br /> Does existing or porposed use make this well public water: Yes f/ <br /> No Sample of well water taken: Yes Na Date taken_ <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Othe ro <br /> posed disposal method <br /> Pol it problem- <br /> 4. F, PC)' <br /> EUj R i'ENTIAL <br /> State possiblqve6tor potential. & ne ssary control: <br /> . r <br /> No. & location existing! _ Additional <br /> facilities needed <br /> 6 . PREVIOUS_ QP_ERAT141 ji TORY <br /> Y , <br /> 7 . GENERAL SAN/rATTON <br /> f State any ro'blems not previously noted: <br /> S . FQRULATJO DEN=_ <br /> Appx No. People per sq. mi ._ <br /> n <br />