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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 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 /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or cOrr,rr,ents <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem : _ <br /> 4 . F G Y�11IO SGS U I T O QTY i :' PSIr _NTI <br /> State possible vector potentift.l & nece.s .ary con.trol . . <br /> 5 . 'I�ylLET/BATH Fig <br /> No . & location exi tin€- _ Additional <br /> facilities needed __- <br /> 6 . PREVIOUS OPERATION HlaTORY <br /> 7 . GENERAL SAKI") ,120. <br /> State any pro t-)lems not previously noted: <br /> 3 . HTUjL�ITL�_1L=i 1-T-V1- <br /> Appx. No . People per sq. mi ._ <br />