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i . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> / <br /> Does existing septic systemcomply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe se tic installation to be installed: A01 e <br /> 2 . WATER SUPPLY <br /> � <br /> Is wa er supplied by private well: Yes o - we11 pr <br /> s oper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this Weil public water: Yee <br /> NoL Sample of well water tarsen: Yes No -x' Date t ken <br /> Results Additional information or comments � � <br /> 3 . GARBAGE & REFUSE <br /> Licenced scavenger pick-up: YesNo., Ser ice 4rea No. <br /> Other proposed disposal method: <br /> Potential problem: o -,Z 6 <br /> PF <br /> 4 . FLY MOSQUITQ OR VZ^.TO PSVT T <br /> State possible vector potentiFtl 8.c necessary control : <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location Existing: Additional <br /> facilities needed - <br /> 6 . PRE,VTOUS OPERATION HISTO r <br /> 7 . GENERAL SAIL11 T-1-CM <br /> State any problems not previously noted: <br /> 8 . EnpuLATION Dr NSTIi <br /> Appx. No . People per req. mi. �lP���/.���G —:QE�ia�-✓� <br />