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1 . SEWAGE <br /> Distance to Public Sewers G /V() "I necessary : Yes- No_ <br /> Does existing septic system comply with Ord , #549 : Yes— No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No Is well proper: <br /> Yes_ No_ State deficiency :_ <br /> 0 (� I i l e L..,. S ,. <br /> Does existing or porposed use make- this well public water : Yes <br /> Na 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 problc-r,,: <br /> 4 . FLYS MOSQUITO OR Vi .TQR PS'r jUTAL <br /> State possible vector patentir,l & necessary control : <br /> NA- <br /> 5 . TOILET/BATH FAC7i-TTES p /No. & location existing : Additional <br /> facilities needed <br /> 6 . PREVrOnS OPERATION -U, , <br /> 7 . MIRAL_SA23.L'rJll'IIIN <br /> State any problems not prevlousl.y noted: <br /> 3 , POPtILATION DENSITY ne <br /> Appx . No . People per sq . r,,i . <br />