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1 . SEWAGF <br /> Distance to Public Sewers G�onnection necessary : Yes N4 _ <br /> Does existing septic system comply with Ord . #549 : Yes No <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 7 _ <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : _ <br /> Does eting or purposed use make this well public water: Yes— <br /> No <br /> _ <br /> esNo_ _L Sample of well water taken: Yes No Dat taken <br /> Results Additional information or comments <br /> 3 . eA RB GE& REFUSE ► // j�p `J,,J , <br /> Licensed scavenger pick-up: Yes No Sere c3 er_l e� <br /> Other proposed disposal method : <br /> Potential problem: _ <br /> 4 . FLYS MOSQUITO QR VECTOR POTIMI AL <br /> State possible vector potential & necessary control : <br /> 5 . TQT , , /BATH FAP,.?. 7Ma <br /> No . & location existii�€ : --'r�_ __ Additional <br /> facilities needed------ <br /> 6 . <br /> eeded _____6 . PREVIOUS OPERATION HISTfIRY <br /> a ,�► �1 <br /> ? . <br /> ear-"_ <br /> State any prQbLmo not previously noted: — .',� �� 9e) , <br /> - - -- = =- <br /> 8 . pCsr'CTLATIc�� UEidSIT <br /> Appx . No . People per sq. mi. __ <br />