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Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #545 : Yes No_ ,r <br /> Unknown— If no, explain: <br /> h <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is grater syPplied by private well: Yes � No is well proper• i <br /> Yes �" No, j-_*4' State deficiency: <br /> Does existing or porposed use make this well public wa er: Yes <br /> No Sample of well. water taken: Yes No Date taken— <br /> Results Additional information or comments # <br /> i <br /> 3 , GARBAGE REM& <br /> Licensed scavenger pick-up: Yes_!��_ NoL Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MQSA_UTTQ C}R_VC's.'�'fiR PCS'-fNTIAL <br /> State possible vector Potenti4l & necessary control: <br /> 5 ClTLET/13ATli FACTLITES, <br /> No. & location existing: --- Additional <br /> facilities needed <br /> i <br /> 6. pHEyjQa5 OPERAITON HISJORM <br /> � R I <br /> 7. C .NERAT. 561ITTATIQ ,,,�....�. <br /> State any problems not previouslY noted: <br /> I <br /> 3 . POPULATIQU DEHaTTY { <br /> Appx. No. People per .sq. mi . i <br /> I <br />