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1 . SEWAGE <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 /> z <br /> 2 . WATER SUPPL`I <br /> Is water supplied by private well : Yes No Is Drell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> NoSample of well water taken: Yes No I-' Date taken <br /> su <br /> Relts 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 . FlLy,_ MOSQU i TO OR VE^TOS PS'f�Ali <br /> State possible vector potentiftl neces,ary control : <br /> 0 1(14 <br /> 5 . TQTLFT/BATH FACILITES 'C � <br /> No . & location existing : _ Additional <br /> facilities needed - <br /> 6 . PREVIOUS OPERATION HISTORY <br /> Y-a G1 <br /> 7 . GENERAL SA UMAT-MOU <br /> State any problems not Previously noted: <br /> 8 . ]L A TTON--MN^T <br /> Apex . No . People per rq . mi . <br />