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-71 <br /> 1 . ;SEWAGE <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 /> Dee cc be septic installation to e installed: T A <br /> PE I e <br /> 1-7 at-!!,292 e — <br /> 2 . WATER SUPPLY <br /> Is wafer ttppJ.iecl L private well : I'es L-7-'No s 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 coMmen-LB <br /> 3 . GARBAGE & REFtISE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OE—Y 'O ? ' �'�1;;MIAL <br /> State possible vector potentihl & necessary control : <br /> 5 . T ILET/BATH FAC L jj,ES <br /> No . & location exi ;till€; : —__ Additional <br /> facilities needed <br /> 6 . PREVIOUS O ATION HlaTORY <br /> 100 <br /> 7 . GENERAL SANITA`t -Off <br /> State any problems not previously noted: ---- <br /> 8 . <br /> H! i .ATI 1 DFM1TY <br /> Appx . No . People per sq. mi ._ <br />