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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes No.Z <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Des ribs se tic installaio to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private Y well: s o Is well proper- <br /> Y! <br /> ✓��5�tttedefigi3p��i.� e n E ,.r y�o✓Ej<'� .�.�.�ia� or" <br /> Does xisting or porposed use make this well public water: Yes <br /> No= Sample of well water taken : Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yeses No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem : ­;�' LZE <br /> 4 . FLY, MOSQUITO OR V CT0 ECi'rjETIAL <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVTOMS OPERATION HISTnRY <br /> ��2�i�r/��r/•�c� <br /> 7 . GENERAL SAIJIT `l-A ION <br /> State any problems not previously noted : <br /> 8 . POPUjLATION DENIST11 1 <br /> Apex . No . People per Gq . mi <br />