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1 . SEWAGE , � f� <br /> Distance to Public Sewers Connection necessary: Yes No--&- <br /> Does <br /> omDoes existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installatiC to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ---" o_iJIs ��ell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use rnalce this weJ-l pu lic 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 scavenger pick-up: Yes No Ser v ce Area No . <br /> Other proposed disposal to hod.- <br /> Potential problem: <br /> 4 . Fj,YL MnSGrfJTTC} n V ^•T�l EC � T <br /> State possible vector potentiFtl necessa y control : <br /> 5 . TOTLET/BATIi FACT ,TTF <br /> No . Fe location existing : — Additional <br /> facilities needed-- <br /> 6 . <br /> eeded -6 . PREVIOUS C_E R,ATjn" L�.T= + <br /> 7 . QENERAL SA tII Alit— <br /> State any problem; not previously noted: - <br /> 8 . <br /> oted: _3 . POPULATION DEN STT <br /> Appx . No . People per 6q . mi . <br />