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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 5URELI <br /> Is water supplied- by private well : Yes NoeIs x�e11 propr: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE& REFUSE <br /> Licenoed scavenger pick--up: Yee No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem- <br /> 4. <br /> roblem:4. FLY. MOSQUITO OR VE-0.222POTENTIAL <br /> State possible vector potenti4l necessary control: <br /> 5 . T-01LEUBATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> S. P.ftF JOUS CEERATTOR HTSTORY <br /> 7 . GENERAL SANTTATTOM <br /> State any Problems not previously noted : <br /> S . POPULAITQM DENSTTY <br /> Apex. No. People per sq. mi.. <br />