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1 . <br /> Distance to Public Sewers Connection necessary: Yes <br /> Does existing septic system comply with Ord . 0548 : 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 Na State deficiency : <br /> w4c( 0111 rte fr- <br /> Does xisting or porposed use make this well public water: Yes— <br /> No <br /> es <br /> No� Sample of well water taken: Ties No Date taken <br /> Re lts Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Othe proposed disposal method: <br /> Paten ial problem: � <br /> 4 . OUTTO OR VECTOR EQ.UNTJA <br /> State po ible vector potential & necessary control.: <br /> 5 . r r � c' .a <br /> No. & location exist Ytg: __ Additional <br /> facilities needed <br /> 6 . PREVIOU0. _-_PERLIQU 1115— RY <br /> 7 . GENERAL SAtiI'Uff-TOOrl <br /> State any proble of previously noted : ., <br /> \__,;;�7 <br /> $ . , - DEITY <br /> Appx! No. People per sq. mi . <br />