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1 SEWAGE� r r� , ,. ' <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.,t46State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken,T_ <br /> Results Additional information or comments <br /> ell-wl It"/ 41��&) a <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . MOSQUITO OR vZ^TM) PC)TUTI <br /> State possible vector potentiftl 8c necessary control : <br /> 5 . TOOT-FT/BATH FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . QEN RAL SA2JIT,ATION <br /> State any problems not previously noted : _ <br /> 8 . POPULATIO14 DEN,zIT! <br /> Appx . No . People per rq. mi. <br /> , . <br />