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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Noz, <br /> Does existing septic system comply with Ord . $1549 : Yeses No_ <br /> Unknown If no, explain: <br /> Deq_eribe se ti lnstal,lation to be installed:--Jc_­�d &-12+ / -__ <br /> 2 . WATER SUPPLY <br /> Is wa er supplied by private well: Yes ,� No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this wellpub is water: Yes <br /> No—4— <br /> Sample of well water taken: Yes NoTDate taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes . No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FL,YL MOSQUITO OR VaT_C E2L N, TIAL � / <br /> State possible vector potentiztl & necessary control : �o4� <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: �' Additional <br /> facilities needed <br /> 6 . PRFVIOU$ OPERATION ;TORY <br /> 7 . UENERAL SANITATION / <br /> State any problems not previously noted - <br /> S . <br /> oted :S . POPULATION Lir i ST .v / <br /> Apex . No . PeoDle Der sq . mi . <br />