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1 . SAGE r <br /> Distance to Public Sewers Connection necessary: Yes�� No_ <br /> Does existing septic system comply With Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY �- `-� ► r^ <br /> Is water supplied by private well: Yes 'flo 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 & RCFU <br /> Licensed scavenger pi <br /> -up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY. MOS©UTTO OR VECTOR PQ' C�'NTTAL <br /> State possible vector potentiftl ?A nececontrol: <br /> 5 . TOTLET/BATH FACTL,TTFS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRRV1TOnS OPERATION H STORY <br /> 7 . GENERAL SAN TATTON <br /> State any problems not previously not-a4; <br /> 8 . POP I .AT Ota D .N;TTX <br /> APpx. No . People per eq. mi: <br />