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�/fi�'r <br /> 1 . SAGE 4-r- <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existin septic system comply with Ord. #549 : Yes No_ <br /> Unknown�f no, explain: <br /> Describe septic installation to be installed: <br /> 2 WATER SUPPLY <br /> Is water supplied by private well . Yes No Is well proper: <br /> Yes No__ State deficiency <br /> Does existing or purposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> /] . <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: _ <br /> 4 . FLI, <br /> MOSQUITO QR Y '"1.QMU=AL � <br /> State possible vector potentirtl & necessary corAtrol : "' ' <br /> 5 . TQI , . l ATH FACILITES <br /> No. & location existing: — Additional <br /> facilities needed <br /> 6 . RVTOTIS_ OPERATION HISTC'}RY_ <br /> r <br /> 7 . GENERAL SA ITA`1_'T M <br /> State any problems not previously noted- <br /> 8 . <br /> oted:S . POS' LA 1914 DEH5JJ-1 <br /> Appx. No. People per sq. mi .-- <br /> �` ` <br />