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1 . SEWAGE ai <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPL`l <br /> Is water supplied by private well : Yes _ No Is well proper: <br /> Yes_ No_ State deficiency: - <br /> Does existing or porposed use make- this well public water: Yes— <br /> No--Z' <br /> esNoXT Sample of well water tarsen: Yes_ No..��. Date taken <br /> Results Additional information or comments <br /> ��E� � '7�/i 7d•,G� j--,� /c�� 'o.�. ion +�*o.� <br /> 3 . GARBAGE & REF[ <br /> Licensed scavenger ick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =1 MOSQU TQ OR V Z'TO P2PTR.TIA:.L <br /> State possible vector potential & necessary control : .� <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed —_ <br /> 6 . PREVIOUS OPERATION Hj;`TO <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8 . POPULATION DEN ^�i <br /> Appx . No . People per sq . mi . <br />