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` SEWeraE <br /> Distance to Public Sewers Connection necessary: Yeses No— <br /> Does existing septic system comply with Ord. #1549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: j <br /> 2. IIATER S[1pPLY <br /> Is water supplied by private well : Yes iso Is well proper: ' <br /> Yes— No State deficiency: <br /> I <br /> .5 <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_ V <br /> 3 . GARBAGE & REEGSR <br /> Licensed scavenger pick-up: Yes No Service Area No. y <br /> Other proposed disposal method: <br /> Potential, problem: <br /> 4• ELY, MQSQUTIQ JQR VZOTO POTENTIAL <br /> State possibly vector potential & necessary control: � <br /> - I <br /> 5 . FACTTLTT <br /> No. & location exieting: Additional <br /> facilities needed6. PREY10aS nPERAI,T.Qni.. HISIORv <br /> 7. GENERAL SANITATION <br /> State any Problems not previously noted: <br /> $ . P-OPULATTON DXNSTTY " <br /> APPx. No. People pet .¢n. mi. <br />