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I . SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 31549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic instaAlation to be installed: <br /> CL 2 . WATER SUPPLY '✓ �� <-C 4.1X/ � <br /> Is wat" supplied by private well : Yes No Is well proper: <br /> Yee No State deficiency : <br /> Does existing or porposed use make- this well public water: Yes <br /> No Sample of well water taken: Yes No ��ajken— <br /> Results Additional information or comments ��k,,� {' <br /> ✓ ♦` <br /> 3 . GARBAGE & REFUSE � �•`�7� <br /> Licensed scavenger pick-up: Yes No Service Area to. <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . Elj-,- MOSQUITQ QR YE^TnjL_PC'fEi1TIAT. <br /> State possible vector potentiFtl necessary control : <br /> 5 . TOLTTFS <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVTOTIS OPERATION HI Tn r <br /> r <br /> Y, <br /> i <br /> 7 . GENERAL SA1U!AT -()- <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DFL STTY ---�� <br /> Appx. No . People per f3q. r,i . <br />