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1 . SEWAGE / <br /> Distance to Public Sewers Connection necessary ! Yes V No_ <br /> Does existing septic system comply with Ord. #549 : Yes_ No_ <br /> Unknown If no, explain: <br /> C�k o- c (L-� e` <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 /> C 6-'P'4 L�-� <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 /> Py A- <br /> ' <br /> 3 . GARBAGE. & RFFUSF <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR V CTOR POTENTTA . <br /> State possible vector potential & necessary control: <br /> O lc- <br /> 5 . TO .F.T/BATH FACTT,TTES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PRFVTQnS O 1RATTON HISTORY s <br /> 7 . GENERAL SANTTATTON <br /> State any problems not previously noted: <br /> 9 . PQPULATION DF.NSTTY _ <br /> Appx. No . People per sq. mi . <br />