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1 . SEWAGE , <br /> Distance to Public Sewers Connection necessary : Yes No V <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> <_ s S �� �o� yy► orn.� �a� cel �Gf <br /> Describe septic installation to be installed - <br /> 2 . WATER SUPPIY / <br /> Is w.--iter -supplied by private well : Yes `� No Is well proper: <br /> Yes No-- State deficiency : <br /> Does existing or porposed use make. this well public water: Yes <br /> No L1_ Sample of well water taken = Ytis No__ Date taken <br /> Results Additional information or corriir,er,ts <br /> 0 P�, <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Na Service Area No . <br /> Other proposed disposal method <br /> Potential problem: <br /> 4 . FLJ� Q QUITO <br /> State possible vector potenti tl & necessary c:antrol --. <br /> 5 . <br /> No . & location existing - __. Additional <br /> facilities needed—_ <br /> 6 . PREVIOUS OPERATION H-1== <br /> 7 . GENEBAL SA14ITA`I'IM]. <br /> State any pros-)leir,s not previously noted : ._—�--- — <br /> Appx . No . People per sq. mi . - <br /> _ _ _ <br />