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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . $1549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER ) T <br /> Is Ovate supplied by private well : yes (G No Is well proper: <br /> Yes No State deficiency : <br /> Does existing 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 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes N ervice Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ESL MOSQUITO OR <br /> State possible vector potentiftl & necessary control - <br /> 5 . <br /> ontrol :5 . TOILET ATH FACILITES <br /> No . ez location existing: _ Additional <br /> facilities needed <br /> 6 . PRFVTOMS 0 { <br /> r i- ck <br /> Zl- <br /> 7 . GENERAL SA2LII TJ-(?N <br /> State any problems not previously noted: <br /> g , pOpULATION DE N r T 1 <br /> Appx. No . People per rq . ral . <br />