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Didtance to Public Sewers u Connection necessary: Yes No x <br /> Does existing septic system comply with Ord. #549 : ' Yes No'� <br /> Unknown-1— If no, explain- <br /> Describe - septic installation to 'be installed: <br /> 2. WTEa OUPPLY <br /> Is water supplied. by private well : Yes ✓ iso Is well proper: <br /> Yes No State deficiency: - - <br /> Does existing or porposed use make this well public water: Yes <br /> No ✓ Simple of well water taken: Yes HOLL 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: 1A +Z <br /> Potential problem: <br /> 4., FLY. MOSAUiTO ORVECTOR j' + - <br /> State possible vector potential & necessary control: <br /> 5 . TQILET/BATH FACTLITES <br /> No. & location existing: °� Additional <br /> facilities needed <br /> 6. PRRYTQUS QEERATInK HISTORY <br /> �C7C✓f M�P.{�. f�I_ )�L(.i(�X�luCr LISrNES S ' <br /> 7. GENERAF, 56N7TATrON <br /> State any problems not previously noted: <br /> 8 . EOEIIL TT014 DENSTTY <br /> Appx. 'ho. People per .sq. mi . RuR✓L - <br />