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SEWAGE <br /> Distance to Public Sewers 72 Connection necessary: Yesy. No— <br /> y <br /> Does existing septic system comply with Ord. #548 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: N <br /> 2 . MATER SUE-ELI <br /> Is water supplied by private well : Yes do Is well proper: <br /> Yes Na State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No__K Sample of well water taken: ides Na Date taken <br /> Results Additional information or comments <br /> I <br /> 3 . GARBAGE & REFUSE <br /> .Libensed scavenger pick-up: Yes No Service Area No,---"- <br /> Other�proposed disposal method: <br /> Potenal problem! <br /> 4 . FLY LC ;NTIAL <br /> State possibN vector potential & necessar control ! <br /> 5 . L,j ET/BATH FAVI TES <br /> No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HIST,. RY <br /> 7 . QEEERAL TTATTON <br /> State ar problem6 not previously noted: <br /> 8 . 1 <br /> Appx. No. People per sq. mi . <br />