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r. <br /> S E VAP31 4 <br /> Distance to Public Sewers r Connection necessary.* Yes Vo­-, <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> Describe sept n bie–i-n,sta1led: <br /> 2 . wATEk _SUPPLY <br /> , r b - <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes_.,._ No� State deficiency :--- - <br /> Does <br /> eficiency : _Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes Nn Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> . Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: � <br /> 4. MQSQUITO OR V1;rTO t=UH� <br /> State passible vector potential & necessary control: <br /> 5 . TOTLETZEATE EACILIM <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PREYIQUS GPERATioN HIST. <br /> 7 , _._3ANTTA,rTQR <br /> State any problems not previously noted.-- <br /> B . <br /> oted.--S . POPULAT_IOU DEMI <br /> Appx. No. People per sq. mi . <br />