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I . SEWAGE <br /> Distance to Public Sewers /�� _ Connection necessary: Yes & <br /> es No <br /> Does existing septic system comply with Ord . #549 : Yeses_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: �% �- <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Ye3 X No Is well proper•- <br /> Yes_2�, No State d e f i c i e n y <br /> 4/EG �v.��✓�/.sc����f �a E.f i� .Bo�o�-c o f,/�9��1���cC�' /YE�/.Gd�osr6 o E/z �Y <br /> Does existing or porposed use make this well public water: Yes <br /> No_� Sample of well water taken: Yes No_V Date take . <br /> Results Ar,�c�,it onal information or comrnent6 � �� � <br /> 3 . GARBAGE & REFUSE <br /> Licenaed scavenger pick-up: Yeses No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELM.,- MOSQUITO QB VZ^T()jLPS?rMTjAL <br /> State possible vector potential & necessary control : <br /> 5 . 'TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed- - <br /> 6 . <br /> eeded6 . PREV I OT12 OPERATION HISTORY- <br /> 7 . <br /> ISTORY7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 8 . pOPULATI(N DE L SITS - <br /> Appx. No . Peop le per cq . r,,i <br />