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r � <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 . <br /> nstalled:2 . W A T E R allMZL <br /> Is water sup lied by private well : Yes v11No Is well proper: <br /> Yes No State deficiency: <br /> �I i9� ori/ c�f�.0 � �. �I �- � vn��✓ <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 & REFUSE <br /> Licensed scavenger pick-up: Yes No__ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLYSn . jO C)_Y Q' ) ' )LI.iI'I IAL <br /> State possible vector potentiftl & neCess­r'ry control : <br /> 5 . FT/BATH +A� S ' <br /> No . & location existing : . —__. Additional <br /> facilities needed __- <br /> 6 . PREVIOUS O +.RATION H=��RY <br /> 7 . GLi NERAL SA14I'_T'A`1 QLT. <br /> State any problems not previously noted , -- <br /> W ] Q14 <br /> oted PTLATIQ14 DE 4S <br /> Appx. No . People per sq. mi ._ — _ <br />