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1 . SEWAGE <br /> Distance to Public Sewere'_ _,� r' I Connection necessary: Yes No <br /> Does existing septic system `Comply with Ord . #549 : Yes No— <br /> Unknown— <br /> o_Unknown � �If no, explain: <br /> 7," <br /> C oil/l'cl�tED <br /> Describe septic installation to be installed:, <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ,_ 'flo Is well proper: <br /> YesA No State deficiency : <br /> Does existing or porposed use rnake this well public Water: Yes <br /> NoSemple of well water tarsen: Yes No Dat tyo�en <br /> Re aupi�, <br /> Additional information or comrneni.'6 <br /> f�f <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes A No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAL MOSQUITO QR V QTO PS)TjajZ?Au <br /> State possible vector potentiF,l & necessary control- <br /> 6 . <br /> ontrol-5 . TOILET/BATH FACj,L TFS <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPER.ATIION H5 =1 <br /> �lc�'/�y/✓1iilF- <br /> 7 . FNS A L SAJjjjA l' <br /> State any problems 2io t previously noted ., <br /> 8 . p2ILATION DE iSITY <br /> Appx. No . People per rq. rni . a -�'<'�/�.!� <br />