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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes—' No— <br /> Does <br /> esNo_Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . MATER 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 t1ris well public water : Yes <br /> No Sample of well water taken: Yes No Date taken <br /> R,�sults Additional in;ormation or comments <br /> I- L -.c U — V, C, <br /> c.. „ ro r l'- C( DsS C' ,nvQoC-A, k "u T S e. <br /> v <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Oth6r proposed disposal method : <br /> Potenal problem: _ <br /> 4 . FLYS r) OR y_ i ) FC)FZNTIAL <br /> State poen ale vector potential & necessary control : <br /> 5 . T��II►ET_LBATH EAC I L I'I <br /> No . & location exist 'yjg : __. Additional <br /> facilities needed <br /> 6 . PREVIOUS HISTL)Ta <br /> f <br /> 7 . GENERAL SAULU1 14 <br /> State any prob_lt-ms not previously noted: - <br /> 3 . <br /> oted: -3 . POPULATIQE DFS i5= <br /> Appx. No . People per sq . mi ._ <br />