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Y <br /> 1 • SEWAUE <br /> Distance to Public Sewers �GConnection necessary: Yes No— <br /> Doss existing Be tic,-sy-tem comply with Ord. #549 : Yes No- <br /> 5 <br /> explain: '+ <br /> Describe septic installation to be installed: <br /> _r <br /> d <br /> 2 . CATER SUPPL`I <br /> Is w te -upplied by private well : Yes A"50 Is well proper: <br /> Yes No State deficiency:— <br /> '.DoeE;Iex_izting or porposed use make this well public water: Yes -/ <br /> No �Sample of well water taken! Yes No mate taken <br /> Results Additional information or comments <br /> 3 . GA BAGS _& REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: i <br /> 4. ELY_,__MOSQUITO OR VZ2.TD$ EC)=IAL <br /> State possible vector potential & necessary control : <br /> 6 . TQILEETIDATH FACILI'i' <br /> No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERAT_I_QN_.HTaT.QRY � <br /> - <br /> 7 . ey)l <br /> A <br /> ! SGid i7 noted <br /> 7.2 <br /> 8 . pOPULATIOUIENSITY <br /> Appx. No . People per sq. mi . <br />