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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes— No_ <br /> Does existing septic system comply with Ord . $1549 : Yes— No_ <br /> Unknown// If no, explain: <br /> N/IJ/�-L 14t-tL <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_ Stat <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 /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLYMOSQUITO OR —VECTOR ZLirL UjA,1L <br /> State possible vector potential R.c necessary control : <br /> 5 . _ <br /> Na F location Fv <br /> facilities needed <br /> 6 . PREVIOfiS ( +.RATToN Hj;`TO <br /> 7 . GENERAL SAtITr '1A TON <br /> State any problems riot previously noted:- <br /> 8 . <br /> oted:_8 . FOPU .AT SON DENSTTX <br /> Appx . No . People per sq . mi. <br />