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1 . SEWAGE <br /> Distance to Public Sewers y Connection necessary: Yes No= <br /> Does existing septic system comply with Ord . 3549 : Yes No_ <br /> Unknown If no, explain: <br /> Desc ibe se is in tpllation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well.: Yes No Is dell proper: <br /> Yes No State deficiency : �LL <br /> Does existing or porposed use make this wellpLib is water: Yes <br /> No_X._ Sample of well water tarsen: Yes No.�Dat taken <br /> Results Additional information or commentsen <br /> •G�.0 a <br /> /r <br /> 3 . GARBAGE & REFUSE � �''� <br /> Licensed scavenger pick-up: Yes Nom Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . =L M SQA ITO OR VZ^.TO EC)M T.IALL <br /> State- possible vector potentiftl Fz necessary control: <br /> 5 . TQTLET/BATH FACILITES <br /> No . & location existing : '�P� Additional <br /> facilities needed <br /> 6 . PRFVTOQS OPERAATION HISTORY <br /> 7 . GENERAL SAIJILTaTION <br /> State any problems not previously noted : <br /> 8 . EOPULATION DENSITY <br /> Appx. No . People per s q. m i . <br />