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1 . SEWAGE <br /> Distance to Public Sewers N Connection necessary: Yes No <br /> Does exist.�g septic system comply with Ord . #549 : Yes No_ <br /> UnknownizL If no, explain: <br /> Describe septic installation to be installed: <br /> /lJ <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes V No Is well proper: <br /> Yeses No State deficiency: <br /> Does/,6xisting or porposed use make this well pu X0 water: Yes <br /> No V Sample of well water -taken: Yes No v Date taken <br /> Results Additional information or comments <br /> & Oy1 <br /> 3 . GE & REFUSE <br /> . Lice \d ,, venger pick-up: Yes No Service Area No . <br /> Otheed disposal method: <br /> Poteoblem: <br /> 4 . 0 OR YEICTOR S 1MI NTIZU, <br /> State possib 111X <br /> vector potential. & nec nary control : <br /> 5 . TQILET/BATH Fha= <br /> No. & location existir, Z_ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATI N (iRY <br /> 7 . GENERALIII^ L <br /> ) <br /> State any ol7lems not previously note : _ <br /> S . POPUt IZ L)E ij=_j <br /> App <br /> . No . People per sq . mi ._ <br />