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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . #549 : 'les_ No_ <br /> Unknown If no, explain: <br /> <� Gras s-, b it- 6hS -fa (71 fy 1� , r <br /> Desribe septiolinstallatio to be installed: <br /> 2 . WATER SUPPT,7 <br /> Is water supplied by private well : Yes _ No-IL Is well proper: <br /> Yes_ No_ State deficiency: <br /> �OVI{ t1, 0 0110.11, ` YI1) ?Jv'r <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 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 . ELJ� MOSQUITO OR —VECTOR ECfj TIA,14 <br /> State possible vector potentiftl & necessary control : <br /> 5 . TQILET/BATN FAr_.ILrTFS <br /> No . & location existing: _ Additional <br /> facilities needed <br /> 6 . PREymns OPERATION j�fOr <br /> 7 . GENERAL SA ?TTATJON <br /> State any problems not previously noted :- <br /> 3 . <br /> oted :_9 . POPULATION DENSTTY <br /> Appx . No . People per r_.q . mi . <br />