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- 4 <br /> Distance to Public Sewers Connection necessary: YesNo_ <br /> Does existing septic system comply with Ord. #549 : Yes ' No— <br /> Unknown— <br /> o_,.-Unknown If no, explain: <br /> Describe septic installation to 'be installed: ,_ ,- <br /> 2. WATER SUERLY <br /> Is wttof supplied by private well.: Yes 110 Is well proper: <br /> Yes ) No State deficiency: <br /> Does a ting 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 . GARAAGE A REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: _ _ Avylo -4 . FLY, MO,9Q[IITO OR VECTOR E!Q'[CNTIATj <br /> State possible vector potential. & necessary control: <br /> 5. TQTLET/BATH FACILITES N <br /> No. & location exiting: Additional <br /> facilities needed <br /> 6. PREVIOUS r_,PERATTOR HISsRY <br /> -C-k V 7 <br /> I <br /> V <br /> 7. GENERAL SAUITA ION <br /> State any problems not previously notad: A/,/W <br /> 8 . POPLJLATif}N DENSITY <br /> APpx. -No. People per .sq. mi. �"l� <br />