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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 /> Ajo <br /> Describe septic installation to 'be installed: <br /> o . , a dc"zs ; ` c S a aw.1'(c <br /> c 16i v s c ! <br /> 2 . WATER SUPPLY <br /> Is watyx supplied by private well : Yes ✓ No Is well proper: <br /> Yes L No State def iciency : <br /> Does e� 1sting 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 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 . FLY. MOSQUITO OR VE^TOR PO'rJ,NTTA , <br /> State possible vector potential P& necesa control: <br /> 5 . t7 i <br /> No, location e. sting: Additional <br /> facil ties needed <br /> 1 <br /> 6 . n c; <br /> 7 . GENERAL SAITTn <br /> State any problems not previously noted: <br /> 8 . POPULATION DENSITY <br /> Appx . No . People per eq . mi . <br />