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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 instal ed: Pr ,vcf -e <br /> L '' '/ i�✓cC /�C,' Oji'� " <br /> 2 . WATER SUPPLY <br /> Is w ter supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Doe existing or porposed use make this well public water : Yes <br /> NoSample of well water taken: Yrs No Date taken <br /> Results Additional information or Comments <br /> 3 . GARBAGE & REFUSE <br /> tensed scavenger pick-up: Yes No Service Area No . <br /> Ot er proposed disposal method : <br /> Pot�Kitial problem: <br /> 4 . FLYS MOSQUITO OR Y ) PSLIEL3T1AL <br /> State pok-ible vector potc_ntiFtl & necessary control : <br /> e, <br /> 5 . TQILET/BFA('.IT ITE.Q <br /> No . & location existing : ___ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION =j, <br /> 7 . GENERAL Y o N. <br /> State any riroblems not previou.s_,ly note — <br /> Aprix . No . People per sq . mi .- <br />