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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes_ 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 _ i1o_ Is well proper: <br /> Yes_ No_ State deficiency :β€” <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 comIfients <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. El, MOSQUITO OR y aTβ€”()RPCf.EaZT-Aa <br /> State possible vector potentirtl & necessary control : <br /> 5 . TOII,ET/BATH FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed--- <br /> 6 . <br /> eeded β€”6 . PR V100S c ER,ATI4i1 13-=' <br /> 7 . GENE RAL-3LIUIAZD-M <br /> Stats any problems not previously noted: - <br /> 8 . <br /> oted: _8 . 'a' 1LATION DEid:)iTY <br /> Appx . No . People per sq . mi . <br />