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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes u No_ <br /> Does existing septic system comply with Ord . #549 : Yes— No_ <br /> Unknown If no, explain : <br /> Describe septic instpall7tign to be installed:�f � vaG <br /> S ur�rtl �' 4 OI M '7�(p1� OI UQeS / <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes X. No_ Is well proper: <br /> Yes No_ State deficiency : <br /> Doe xisting 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 . <br /> L ensed scavenger pick-up : Yes— No_ Service Area No . <br /> 0th proposed disposal method: <br /> Poten ial problem : <br /> 4 . FTY ITO OR VECTOREOPLNTIAL <br /> State poss le vector potential & necessary control : <br /> 5 . T1 r <br /> No. & location exists __ Additional <br /> facilities needed <br /> 6 . <br /> 7 . <br /> State any pro ems not previouslynote . <br /> 3 . )PTJTATXt ,�DENSITY <br /> Appx. o. People per sq. mi . _ <br />