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1 . SEWAGE — <br /> Distance to Public Sewers Connection necessary : Yes_ No X <br /> Does existing septic system comply with Ord . $1549 : Yes_ NoX_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: N�`� isr7e�c 4,•-4 .� <br /> inv r/ n/e., !'X*fV .f <br /> 2 . WATER SUPPr.Y <br /> Is waterplied by private well : Yes No Is well propel: <br /> Yes NoState deficiency : <br /> Does,Axisting or porposed use make this well public water: Yes— <br /> No— <br /> les <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes / No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY , MOSQUITO OR VECTOR �[if�TIAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: /�4 Additional <br /> facilities needed <br /> 6 . PRRVIOUS OPERATION HISTORY <br /> 7 . G .N .RA . SAt7 TA'1'7ON <br /> State any problems not previously noted: <br /> a . POPULATION DENSITY <br /> Appx. No . People per eq. mi . <br />