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r { <br /> 1 . SEWAGE r <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 /> Describe septic installation to be installed: <br /> 2 . WATER SUPPL`I <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water tarsen: 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 . yL MOSQUITQ QR VZ^,TC) Mi'j'fN� TIAL <br /> State possible vector potentiftl necessary control : <br /> 5 . ZQILET/$ATH FACILITES <br /> No. & locution existing : — Additional <br /> facilities needed _ <br /> 6 . PRFVTOUS OPERATION HISTORY, <br /> 7 . QENERAL SANIT,&TION <br /> State any problem: not previously noted : <br /> 8 . POPUL TIO14 DENSITY <br /> Appx. No . People per rq. mi . <br />