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1 . SEWAGE ' <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord . $1549 : Yes No_ <br /> Unknown �( / /I f no, explain: <br /> uvl`LY�'' <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 porposed 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 /> 3 . GARBAGE & RRFUSE <br /> Licensed scavenger pick-up: Yea No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSQUITO OR VCQTOR PO'r CNTIAL <br /> State possible vector potentietl & necessary control : <br /> 5 . TnILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREViOU2 OPERATION HISTORY <br /> 7 . GENERAL SANIJA <br /> State any pro.b eme not previously noted : — <br /> 00 <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per eq. mi. <br />