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1 . SEWAGF <br /> Distance to Public Sewers LA Connection necessary: Yes NoaL <br /> Does existing septic system comply with Ord . 11549 : Yeses No— <br /> Unknown- <br /> o_Unknown If/ no, explain: <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 State deficiency : <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 cavenger pick-up: Yes No Service Ar No. <br /> Other prop ed disposal method: <br /> Potential pro en,: <br /> 4 . FLY L S6 'TOR p�i'MMT <br /> State possible vec r potentiftl & nece ry control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: `� Additional <br /> facilities needed <br /> 6 . PRFVIO17S CIPERATTON STORY <br /> 7 . Q .NERAL SAIJIT `l_A 'ION <br /> State any problems not previously noted : _ <br /> 8 . POPULATION DENSUX <br /> Appx . No . People per Bq . mi . <br />