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1 . SEWAGEiO-A'c <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 /> Descri_b ___s-eptic_ installation to�'`b installed: 1/� <br /> Z . Up � <br /> WATER SUPPLY <br /> S_ _ �� 104e <br /> Is water supplied by private Well : Yes ilo Is dell proper: <br /> Yes :L No State deficiency : <br /> Does existing or porposed use make this well public Water: Yes <br /> -- - Sample of well water tarsen: Yes N� Datt ken <br /> Results Additional information or comments ' <br /> 3 . GARBAGE & REFUSE �" ,ct <br /> Licensed scavenger pick-up: Yes No Service Area Jo. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4 . <br /> roblem-4 . =L MOSQUITQ OR V E^.TOS FQ r :,LT 1. <br /> State possible vector potentiitl & necessary control : <br /> 5 . TQILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVI00S QPER.ATION H ; X <br /> 7 . GENERAL SAttI'r, J'I(-N <br /> State any problems not previously noted: __ <br /> 3 . F > Ij,ATION T)F <br /> Appx. No . People per cq . mi . <br />