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} <br /> SEWAGE <br /> Distance to Public Sewers IA– Connection necessary: Yes No� <br /> Does existing .septic system comply with Ord. #548 : Yes.-Z— No_ <br /> Unknown If no,. explain: <br /> Describe septic installation to 'be installed:., <br /> 2. WATER SUPPLY <br /> Is water supplied- by private well ' Yes � ¢�o Is well proper: <br /> Yes _ No State def+ciency: <br /> Does existing or porpo$ed use make this well public water: Yes <br /> No - Sample of well Water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARAGE & MEUSE <br /> Lice.noed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal meth <br /> Potential problem: <br /> 4- FTy, MQSQUITOCT02 PQ'[CSTTAL <br /> State possible vector potential & necessary control: <br /> 5 . O <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . BHEVjQU$-QPMRAjT0M HISIORY. <br /> 7 . G <br /> State any problems not prev-Lausl7 noted: <br /> $ , popULATTOIT •.....7TH <br /> Appx. No . People per eq. mi. <br />