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1 . SEWAGE <br /> Distance to Public Sewers ' Connection necessary; Yes--- No— <br /> Does existing septic system comply with Ord . #549 : Yes No— <br /> Unknown If no, Explain: <br /> Describe e;eptic installation to 'be installed: <br /> 2 . WATER SEPPI,Y <br /> Is water eupplied by private well : Yes AL Lmo is well proper: <br /> Yes No State deficiency : <br /> !'W 3 <br /> Does existing or purposed use make this well public grater: Yrs, - <br /> No— Sample of well water taken: Yes No `s Date taken <br /> Results Additional information or comments <br /> z. <br /> F <br /> V. <br /> 3 , GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potentialf ra : <br /> probl , . <br /> 4. FLY_, IQSQTJITf_j. E1RVEQTOa_PS�fZETZALL <br /> State possible vector potentif►l 84 necessary control.: <br /> 5 . TOILr T/BATTI TAGILI'I'ES <br /> No . ec location existing <br /> Additional <br /> facilities needed <br /> 6. PREYTQTIS OPERA I0% H1ST.QnY <br /> 7 . GENERAL SAP ;r ', T��_N <br /> State any problems not previouuly noted - <br /> 8 . <br /> oted :S . F-22ULATION DE $,,ITY <br /> Appx. No . People per sq . mi. . <br />