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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord . #549 : Yes_ No L <br /> Unknown If no, explain , <br /> k) n Lt -JAI <br /> Describe septic installation to be installed: 'VG�CA "�fiV1 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes Hop_ Is well proper: <br /> Yes_ No vL State deficiency : <br /> )Pad 0 lu s) <br /> Does "isting or porposed use make this well public water: Yes <br /> No < Sample of well water taken : Yes_ No� Date taken <br /> Results Ar�diti-onal information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes—< No_ Service Area No . <br /> Other proposed disposal metY�E, : <br /> Potential problem : - <br /> 4 , ELY. MOSQUITO OR VZ^.TO EU y MAL, <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACII,jTES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HISTORY <br /> rar,tvy <br /> 7 . GENERAL SAPlIT �1PJ� 'ION <br /> State any problem~ not previously noted . _ <br /> S . PC)PULAT tt)FFiJ,ITY <br /> Appx. No . People per sq . mi . 64- jig( <br />