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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No-- <br /> Does <br /> o—Does existing septic system comply, with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: <br /> De cribe septic installation to 'be installed: .1'/-'. 1e <br /> Z . WATER SUPPLY <br /> Is water supplied by private well : Yes : i1o.� 8 w 11 proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make thin well public Water: Yes <br /> No_4__ 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 problem: <br /> 4 . FLY. MOSQUITO OR VZ^.T� _02 M)CENTI_AL <br /> State possible vector potentiitl & necessary control: - <br /> 5 . TOr , .TZBATH EACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . pRFVIntT,S„ OEERATToN HI sTngy <br /> 7 . GENERAL SAIJI. 1'Zp IQN <br /> State any problems not previously noted: <br /> 3 . pnPULATTON DE STTY <br /> Appx . No. People per eq . mi . _��/ r/,��.ff�f✓�Jf��.� <br />