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1 . SEWAGE <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 SUPPI,! <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State def icie.nev : _-- <br /> Does existing or porposed use make this well public water: Yes <br /> No Semple of well water taken: Yes No Date taken <br /> Results Additional intorMation or comments <br /> 3 . GARBAGE & REFUSE 1Y _11 f_ t c,.-x" I' •✓` C�.e�•Y+ f's`r.' �,, <br /> Licensed scavenger pick-up: Yes— No— ServiceC mea,fio + <br /> Other proposed disposal method: <br /> Potential problem: "�-- <br /> 4 . F _ r�OSFrUITO OF�YfT� <br /> State possible vector potentiFtl & necessary control : <br /> 5 . ` PULE /BATH FACT=1a <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PRR-E�VIOUS OPERATION H.I L)RI <br /> 7 . GENERAL SANITAMMU <br /> State any prok)lems not previous,ly noted : _ <br /> 3 . POPULATIc?N .M=YIE <br /> Appx. No . People per sq. mi . - <br />