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.. 7s <br /> 1 . SEWAGE <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 /> n. <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes ilo 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 <br /> Results �( Additional information r comments ` <br /> �` .D � � A <br /> 3 . GARBAGE & REFUSE <br /> Ov G4.,i <br /> Licenced scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =. MQSQUITQ OA VQ!T(-) E2MET?AL f" <br /> State possible vector potentiftl nege.16sary control : <br /> 5 . TOILET/BATII FACILITES) <br /> No. & location existing: _-- Additional <br /> facilities needed _ <br /> 6 . PREVTOPS OPERATION JS-= <br /> 7 . GENERAL S A N I'r,_g j_() <br /> State any problems riot previously noted - <br /> 8 . <br /> oted :8 . F > IL1ATI0j4 hE iISTTY <br /> Appx. No . People per rq. mi . <br />