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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No, <br /> Does existing septic system comply with Ord. I1549 : Yeses_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to "be installed: <br /> 2 . WATER SUPPLY <br /> Is water s pplied by private well : Yes Z No Is well pro" er: <br /> Yes No V State def igi:.ncy: �gL,- .i"� �•6'maw ��'-� � ;;0 <br /> v Ve. o e f Ei1' ��1•�E '''`� '',_t' .t..�'B��°,r rC,d <br /> Does existing or porposed use make this well `public water: Yes <br /> No_.L_ Sample of well water taken: Yes Nom. Date. taken <br /> -7— <br /> Results �r �Add ti Jf�1 mat on or comme /t+o <br /> ��"i 'i"� o g�/r�Nw <br /> 3 . GARBAGE & REF 1S . <br /> Licenced scavenger pick-up: Yes''_ No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FLY, _ MQI,;Q ITT0 OR VZQ-T M ,NTIAL <br /> State possibly: vector potential necessary contro � o� <br /> 5 . TOILET/OATH FAGILITE <br /> No. & location existing: �'" ` " Additional <br /> facilities needed <br /> 6 . PRi, .VI02 0EaRATIOU HISJQRX <br /> 7 . GENERAL SAITTIATION <br /> State any problem✓ not previously noted: <br /> 9 . ROP I LAT -QI DENST_Tv <br /> Appx. No. People per sq. Mi. . <br />