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le) <br /> � . 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 <br /> eficiency :Does ex ting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No �!/� Date taken <br /> Results Additional information or comments loll <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: ___ <br /> 4 . FLYS MOSQUITO O-Y M(M-P2r ' 1 <br /> State possible vecto:- potential. & necessary control- <br /> 5 . <br /> ontrol:5 . TQI LET/BATH FAQT L I'I'ES <br /> No . & location existliig: — Additional <br /> facilities needed—­ <br /> 6 . <br /> eeded _6 . PRFVTOIS OPERATION HI )TORY <br /> 'T.���`1tr�-sQ� ���►� �. � ��� d��7 � .� 1"�l i ':n Z�/-moi <br /> r <br /> Z� <br /> 7 . GENERAL SANT'rA <br /> State any problems not previously noted _ <br /> 8 . POPULATIQN _DENSI'TY- <br /> Appx . No . People per r-cl . mi . <br /> ,57, <br /> 77 <br /> f' -p <br />