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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 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 /> NoSample 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 /> P-otential problem: <br /> i <br /> 4 . FL"YOSQUITO OB EfQTQR_ZC)rjjUZjAL <br /> State ossible vector potentitil necessary control : <br /> 5 . n ^ <br /> No. Fi locatior, e iSting. Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPER T OF(Y <br /> 7 . GENERAL SAPlIT '1,14 'ION <br /> State any problems not rev,( C__`y oted : _ <br /> S . POPULATION DEN1SUIV <br /> Appx. No . People per sq. mi . <br />