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1 . SEWAGE. <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 11549: Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied, by private well : Yes Na Is Ezell proper: <br /> Yee No State deficiency: <br /> o K,6 <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 informationAor comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick--up: Yes No Service- Area No . <br /> Other proposed disposal method: to A- <br /> Potential problem: <br /> 4• FLY MTENTIAL <br /> State possible vector potentiztl PA necessary control- <br /> PM V6:N 7 STAtA Art 14 d-- WA-C <br /> 5 . M M5 , <br /> No. & location existing: Additional <br /> facilities needed t L TOLLet S - - - - -- - <br /> y i <br /> 6. PRRVTOT12 QERgATIoN HTSTngX <br /> 7. ., n <br /> State any problems not previouw ly noted.-- <br /> 8 . <br /> oted:-8 . ROPULATIQU DENSTTY <br /> Appx. No.. People per .aq. . mi . <br />