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V <br /> i . 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 septic installation to be installed: <br /> 2 . WATER SUPPLY <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 Sample of well water takers: Yes No Date taken <br /> Results Addi Tonal information or comments ✓ " aT <br /> !� \ <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 YECTOR POEENTIAL <br /> State possible vector potentin.l & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREy_IQUS OPERATION HISTORY <br /> J <br /> 7 . GENERAL SANIT TION <br /> State any problems not previously noted: <br /> 8 . POPULATIQN DENSITY -- <br /> Apex . No . People per sq . mi ._ <br />