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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 /> Degcribe septic installation to be installed: 1 i .. JIjal <br /> t + Orr <br /> 1f' <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 /> No Sample of well water taken: Yes No Date taken <br /> Results 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„ VECTOR FS3'ME IAL <br /> State ossible vector potential & necessary,"control: <br /> 5 . ZQ <br /> No. & location e i :tir�g: Additional <br /> facilities needed <br /> 6 . � i ORY <br /> i <br /> 7 . GFNtII.'A` ION <br /> State a problems not previously noted: <br /> s . QLLMi5JJ-1 <br /> ,Kppx. No. People per sq. mi ._ <br />