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1 . SEWAGE <br /> Distance to Public Sewers AJ4 Connection necessary: Yes_ No <br /> Does existing septic system comply with Ord , #549 : Yes No_ <br /> Unknown If no, //explain : <br /> ai m Ye✓u. # 97-`X6 <br /> Describe septic installation to be insta3led: <br /> /two, -7t c Sa � / <br /> Z . HATER SUPPLY <br /> Is wat r supplied by private well : Yes 'Ho_ Is well proper: <br /> Yes No_ State deficiency : — <br /> Does existing or porposed use make- this well public water: Yes <br /> No ✓ Sample of well water taken: Yes_ No t-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 . FLY . MOSoUITo ORV �^TC1 PSj'I'JsNTTAL <br /> Stateible vector potential & necessary contr <br /> 5 . TQ r ^ <br /> No . & location exists _ Additional <br /> facilities needed <br /> 6 . PREVTOMS nPERATION HISTM <br /> 7 . GENERAL SAN TQN <br /> State any prob ems not previouoly noted : _ <br /> 8 . POPULATION DEN3,TTY <br /> Appx . No . People per sq . mi . <br />