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s �S-53T <br /> . <br /> SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No- <br /> Does exist ng septic system comply with Ord. #549 : Yes No_ <br /> Unknown V If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes tlo Is tiiell proper: <br /> Yes No State deficiency : <br /> Does exit-ting or porposed use make this well pup lie water: Yes <br /> No__,,,,,, ample of well water tarsen: Yes No _e' Date taken <br /> Results Additional information or comments -d <br /> 3 , GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes Noer�Area t o. -� <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . L MOSQUITn OR VECTOR CTO PC'frNj_TATj. <br /> State possible vector potential & necesaary control : rIC <br /> � <br /> ''�" M <br /> 5 . TOILET/BATII FACILITES <br /> No . & location existing : Additional <br /> facilities needed _ <br /> 6 . PRFVIn(1a (;PI RATIni•I Hj;,T(� <br /> 7 . j. 2A1LI'rA'1'ION <br /> State any problem: not previously noted : <br /> 8 . pL) ILATIQU r)Ei ST <br /> Appx. No . People per sq . mi . <br />