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1. SEWAGR <br /> Distance to Public- Sewers N� Connection necessary: Yes No-Z <br /> Does existing septic system comply with Ord. #549 : Yes No_,_, <br /> Unknown. It no, explain: <br /> Describe septic installation to 'be installed: /VG <br /> 2. WATER SUPPLY . <br /> Is water supplied- by private well : <br /> Yes iso is well proper: <br /> Yes No State deficiency: <br /> 'Does existing or Pornosed <br /> 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 & REFUSE <br /> Licenoed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MQSGUIIQ OR ECTOR ,I <br /> State possible vector potential- RA necessary control: <br /> 5 . n <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOL75 OPERATION <br /> 7 . GENERAL SAHITA'ijQS <br /> State any problems not previously rioted: <br /> S . f] " <br /> Appx. No. People per sq. mi . <br /> I <br />