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1. 'jtUAUF (2) <br /> Distance to ioublic Sewers Connection necessary: Yes N <br /> Dose existing septic o <br /> I! iso, explain:' . systea ooap y with Ord. X549: Yes No U <br /> Describe sdptic installation to be installed: <br /> Additional information or oomments: <br /> 2• WATER SUPFLY <br /> I� 'Water supplied by private well: Yes <br /> S.t to deficiency: S t10 Is wail proper: Yea NO <br /> �e__f�� <br /> Does existing or proposed use make this well public water: Yea _ No <br /> Sample of well water taken: Yes _ No Date Taken Results~ <br /> Additional information or comments: <br /> 3• GARBAGE & RF-FUSE <br /> Licensed scavenger pick-up- Yes _ No _'Service Area No. <br /> Other proposed disposal method : <br /> Fotential problem: <br /> 4- FLY, MOSQUIYO OR VECMR 1-0'ITNTIAL <br /> State possible vector potential & necessary control: <br /> S. AIR 110LMTIo:: 1'07EIII'IAi, <br /> �3LaLe poyslo_e UurninL: OS' P"Ceb:,lUg I,u1luLanLs & necessary control: <br /> 6. TOILF;T/BATH FACILITIES <br /> NO- & location existing: Additional facilities needed <br /> 7. I'havluu:; U! ..r ,rI014 II1 ; l tfY <br /> b. GENERAL JA1,iiAT1w <br /> SLaLo arty Problems nub <br /> 9- POPULATION DENSITY <br /> Appx, No. people per sq. mi . <br />