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1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes Ito_ <br /> Does existing septic system comply with Ord . #549 : Yes No, <br /> Unknown If no, explain: T�,p &, x ; - <br /> Describe seRtic instal t_�._ou .to-'be installed: <br /> r <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ' o 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 tarsen: Yes No Date taken r <br /> [/ IIResults Additional information or comments ? C".k' I S <br /> 3 //* <br /> 3 . GARBA4�& EFUSR 4�1 2 <br /> Licensed scavenger pick-u Scic rea No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . L MOSQUITO OR Z'1.T PCTjNTT_AL <br /> State possible vector potentiitl 8c necessary control : <br /> 5 . TOTLET/_Bpi FACILITES <br /> No . & location existing : _ Additional <br /> facilities needed _ <br /> 6 . PREVIOUS (TERATTON H ,Tr, <br /> i <br /> 7 . GENERAL SAPaI'r.,A`j'ION <br /> State any problems not previously noted: - <br /> 8 . <br /> oted:8 . EJO > ILATION DE11 = <br /> Appx . No . People per oq . mi . <br />