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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 /> N\) Se-pro c 3j &I d'ft) <br /> Describe septic installation to be installed: <br /> f`16N �i <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No ' Is well proper: <br /> Yes_ No_ State deficiency: <br /> No W'- ir Pf&laiRe <br /> Does existing or porposed use make this well public water: Yes— <br /> No )<, <br /> esNo;)<, Sample of well water taken : Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & RFFUSF <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . ELJ� MOSQUITO OR YE,,ITO pC'rLtITIAL <br /> State possible vector potentirtl & necessary control : <br /> N0" ( <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PRFVTOf1S O ,.RATION HIBTORX <br /> NON (. <br /> 7 . GENERAT, SAtJITATION <br /> State any problems riot previously rioted: Q�JVNlS <br /> 9 . POPU ,ATTON DEIISTIY <br /> Appx . No . People per sq . mi . <br />