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NNN �I <br /> 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 stalled: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> j <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 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 VE^.TO PS'fjBjTAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . TO "T/ ATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PRFVI002 OPERATION <br /> 7 . GENERAL SAPUT,J, TJ-Q__N <br /> State any problem: not previously noted: — <br /> 8 . EnP LLAT I ON DE `'T X <br /> Apex. No . People per rq . mi . <br />