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W .. <br /> 1 SEWAGE JVr <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 w 11 proper: <br /> Yes No State deficiency: �� 'c <br /> D� SCI&N?Rg96fr'� rf;16�6ed use make this well public water: Yes <br /> No Sample of well water taken : Yes Noiz_ Date taken <br /> Resul s 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 . FLY. L MOSQUITO OR yT:CTOR E2rENTIAL <br /> State possible vector potential & necessary control: -+�4''� <br /> 5 . TQTLET/BATH .FACILI ' ,S <br /> No . & location existing , �/ Additional <br /> facilities needed _ <br /> 6 . RRVTQT1R QPERATTON HISTORY <br /> co <br /> 7 . GENERAL SANITATIQN <br /> State any problems not previously noted: ��>� <br /> S . P s P i ,ATIQN DENSIT-1 <br /> Appx . No . People per sq . mi. <br />