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?9 A dv <br /> 1 . <br /> '7 <br /> SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> - T D <br /> 2 . WATFR SUPPLY ta, .,V 7 eo A fit-�'� <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes_.,No_ State deficiency : <br /> T� � do 17 9 7 2 71-¢71 .��✓1 y, �i ,� � � 5 <br /> / 7 A9 ! /1 TF � <br /> Does existing or porposed use make this we 1 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 . FAL MOSQUITO OR V , ZCirCNTTAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TOT ET/BATH FACILITES <br /> No. & location existing :_ Additional <br /> facilities needed <br /> 6 . PR .VTO(IS OPE T S QRY <br /> -4e ijam-1 <br /> 7 . GENERAL SAtITTATION <br /> State any problems not previousld: <br /> 9 . PO 1 .ATIO14 DENSITY <br /> Appx . No . People per sq. mi . <br />