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1 . SEWAS3F <br /> Distance to Public Sewers Connection necessary: Yes No4 <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: %ter` <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well: Yes iso Is tiiell proper: <br /> Yes. No State def icieney :11'at.'G� <br /> Does existing or porposed use make this well public Water: Y s <br /> No Sample of well water taken: Yes No.%,�— Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes - ' No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FLY L MOSQUITO SSR V E CTCV ZC)rLHTSA.Tj <br /> State possible vector potentiftl Fz necessary control : eot-y- <br /> 5 . TOTLET/BATH FACILITES) <br /> No . & location existing : �«�'E �� Additional <br /> facilities needed _ <br /> 6 . PREVIOUS c�PEgATInN H n <br /> 7 . GENERAL 5A1L1'r,1 ' -C <br /> State any problems not previously noted : <br /> 8 . 2nPULATION DEt ` T y ' <br /> Appx. No . People per rq. vii . �� <br />