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Distance to Public Sewers Connection necessary: Yes No�I/ <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain: <br /> Deser�be septic instalation to 'be installed: <br /> Z. WATER SUPPL`I <br /> Is water supplied. by private well : Yes ✓ No 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 taken: Yes No . Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSk <br /> Licensed scavenger pick--up: Yes No Service Area No, <br /> Other proposed .disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUITO nR VG^TQR-PEENTIAL <br /> State possible vector potential & necessary control: - - - <br /> 5 . <br /> ontrol:5 . T,QLET/BATH ' FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PRE,YIQUS OtERAIION HISTORY <br /> 7 . GENERAL_ �STION <br /> State any problems not previously noted.-- <br /> 8 . <br /> oted.--8 . P-OPULATIQIJ DFt�'V <br /> Appx. No.. People per .act, mi . <br />