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2 <br /> i <br /> 1 . SEWAGE <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 <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 /> NoSample of well water taken: Yes No Date taken <br /> Res ts— Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> icensed scavenger pick-up: Yes No Service Area .No . <br /> her proposed disposal method: <br /> Po ential problem: _ _-- <br /> 4 . FLY OSE►UITO OR y EC)FENT.IAL <br /> State PQssible vector potentifLI & necessary`control: <br /> 5 . TQ. LET/BATH FACI`R.I'laa <br /> No . & location exi y►. frig : Additional <br /> facilities needed <br /> 6 . PREVIOUS -LEEMION HST_ <br /> ,1 <br /> 7 . GENERAL SAKI,&tMU <br /> State any px`olilems not prev_i_oti..�7.y note�� <br /> i <br /> ~'a <br /> 8 . POPULAT I OX. =_y_ <br /> Appx. No . People per sq . mi . - <br />