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- (2) <br /> 1. SEWAGE <br /> Distance to Pubis Sewers ction necessary: Yes No <br /> Does existing septic system co ipy with Ord. #549: Yes No ® Unknown <br /> If ,, explain: <br /> Describe septic installation to be installed: <br /> Additional information or c ents: <br /> 0.r <br /> 2. WATER SUPPLY <br /> In water suppliedprivy : Yes .4 No r Is well proper: Yes No <br /> State deficiency: <br /> Does x t or proposed use make this well public water: Yes o r <br /> Samplef well water taken: Yes o Date Taken Results <br /> Additional o do or comments: -- " b Vit- <br /> . <br /> GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Too No Service Area No. <br /> Other proposed disposal method: <br /> Potential p : <br /> 4. Ega.M.DSWIM OR VXC70R POTEN <br /> State possible vector ni c ss control <br /> IPA 141, <br /> . <br /> possibleor 'P cs Mutants & necessary control: <br /> —FACILITIES <br /> No.' & location existing: Additional facilities needed _ <br /> . PREVIOUS OPERLTION HISIORY <br /> $. I ON <br /> State obl s not previous noted: <br /> POPULATION I <br /> . People per s . mi. <br /> mi o6 o6 <br /> a <br /> /71 . 3/71 750 <br /> +s A :� <br />