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t <br /> 1 • SEWAGE <br /> l J <br /> Distance to Public Sewers % L` Connection necessary: Yes L 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 /> C�/ �( <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is dell 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 /> Licensed scavenger pick-up: Yes/ No Service Area No. <br /> Other proposed disposal metho4: I) <br /> Potential problem: <br /> 4 . =� MOSQUITO QB V Z^T() PCi'r11N11AL <br /> State possible vector potentiftl ?A necessary control : <br /> 5 . TOILET/BATH FACIL,JTEG <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREY_TOfIS OP .RATION HISTORY- <br /> 4'L <br /> ISTO r f .� P ',y,•. l' <br /> 7 . QENERAL S ArL1! '1�H <br /> State any problems not previously noted <br /> 8 . POPULATION DEI `STTY <br /> Apex. No . People per req . mi . <br />