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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 Apstalled: <br /> ex <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes io Is well proper: <br /> Yes-L.- No State def-1 cieney : �o--,-f= —� /��ti ✓���6 �'`a <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 . FjLy_L MOSQUITO OR V QT() ZCi'r VjTAL <br /> State- possible vector potentiftl necessary control : <br /> 5 . TO ,ET/BATH FA,CTI�ITES <br /> No. & location existing. _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OP +.R.AT ION HISTnFiY_ <br /> 7 . GENERAL 2ANTT.9:IQN <br /> State any problems not previously noted: � - <br /> 8 . POPULATION DENSTIX <br /> Appx. No . People per rq. mi . <br />