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1. SEWAG S ` <br /> Distance to Public Sewers 2� Connection necessary: Yes No_,,,. <br /> Does existing septic system comply with Ord. 0543 : Yes No— <br /> UnknoWn—Y-_ If no, explain: <br /> Describe septic installation to *be installed: <br /> / a-'-t <br /> 2 . WATER SURPLY <br /> Is water supplied. by private well., Yes No >C Is well proper: <br /> YeB No State deficiency: <br /> o -ce.fs .Ces'V'2d � d <br /> F <br /> Does existing or pornosed 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. GAEBAGE & REEME <br /> Lic sed scavenger pick-up: Yes No Service a No. <br /> Othe roposed disposal, method: <br /> Potent 1 problem: <br /> 4 . E—,TCR FUC �NTIAL <br /> State possi e vector potential & nec nary control: <br /> 5 . MILET/BATH FACILITE.� <br /> No. & location existing. Additional <br /> facilities needed <br /> 6 . PREYjQQEj Q)EE-RAT HTSIXORY <br /> 7 . GENtRAL SAI IATION <br /> State arly problemw not Previously rioted. <br /> S , 1 T I <br /> Appx. No. People per ..an mi . <br /> I <br />