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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . 1$549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is Water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public dater: Yes <br /> No _ Sample of wel`. water taken- Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAG;' & REFUSE <br /> Licensed scavenger Fick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:____ <br /> 4 . FLY. MOSQUITO QR YriQTOR POTEUTTALL <br /> State possible vector potential FA necessary control: <br /> 5 . TnILET/BATH FACILITES <br /> No. & location existing: _ Additional <br /> facilities needed <br /> 5 . PRRVTOUS OPERATION HIS. T_ ORY <br /> 7 . GENERAL SANITA TTON <br /> State any problems not previously noted : <br /> S . POPULATIn„14 D °, TTY <br /> Apex . No . People rer ca . mi . <br />