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1 . SEWAGE �, <br /> Distance to Public Sewers Connection necessary : Yes No <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: <br /> Descrj.be_...eep-tica­ ara$tallation to 'be�in Ard <br /> 2 . MATER SUPPLY <br /> Is water supplied by private well : YesLio Is well proper: <br /> Yeses No S I ncy + '-77 <br /> f� <br /> Does existitg or porposed use make this well public Water: Yrs <br /> No &attiple of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Flo Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY-.1- MOSQUITQ OR yz^TC) z2rT T—U'L <br /> State possible vector potentiitl & necessary control : <br /> 5 . TOILET/BATFSAClj,T 'El- <br /> No . & location existing_ _ Additional <br /> facilities needed _ <br /> 6. PRF�YIOrT,5 OPI R.ATIn_ i•1 H ATX <br /> 7 . GENERAL SAIUI �1,A 'L <br /> State any problems not previously no-t�l.- <br /> 8 . PO P LATIOt4 DE i4,15TJv, <br /> Appx. No . People per rq. mi . -- - <br />