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S r SEWAGE w <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 /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied. by private well: Yes � iso Is well p-roper: <br /> Yes-X'. No State deficiency:..ao'—wok <br /> �Q��l �. <br /> Does existing or porposed use make this well public dater: Yes <br /> - <br /> No-/,,- Sample of well water taken: Yes Nom Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & EEFUSE <br /> Licensed scavenger pick-up: Yes, No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, tQSAOITt] OR Vru,T-02 POTENTIAL <br /> State possible vector potentiftl & necessary control:,, <br /> 5 . MIT-ETZEATHAUGILITES WO-'- <br /> No. & location exiting: Additional <br /> facilities needed <br /> $ . PRRYTQaS QI!ERAITQU HISTQRY <br /> 7 . <br /> State any problems not previously noted:. <br /> S . Q 1 T v <br /> Appx. No. People per .sq. mi. <br />