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r � <br /> 1 . SEWAGF <br /> Distance to Public Sewers Connection necessary: Yes_ <br /> Does existing septic system comply with Ord. #549 : No <br /> Unknown If no, explain: 'les No <br /> Describe septic installation to 'be installed: <br /> Z. WATFR supPr.7 <br /> Is water suppliedby private well : Yes iso Is wellYes No State defici:.ncy: proper: <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 /> Al .7 i v ✓ <br /> 3 . GARBAGE & RfiFT15F <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FL . MOSOUTTO TI frnR MrIlTIrNTTAT <br /> State possible vector potentiitl & necessary control: <br /> 5 . TQILFT/BATH W AC T T.TTF'S <br /> No. et location existing: Additional <br /> facilities needed <br /> 6• PREVIOUS nn RAT TON wT^TnR <br /> 7 . GENERA . SA 7TTA'PTQN <br /> State any problems not previouZly noted : <br /> 9 • PnPTMA'TT(W r)FV;TTy <br /> APpx. No . People per eq . mi . <br />