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f . BKWAGE <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 SURELY <br /> Is water supplied by private <br /> Drell : 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 & REFUSE <br /> Licenued scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MQSOU LTQ QR_YECTOR PQ'[2,MTTAL <br /> State possible vector potential u necessary control: <br /> .5. n EACILITEa <br /> No. & location existing: Additional <br /> facilities needed �~ <br /> 6 . P.REVIOng O EATInU HrsingX <br /> 7. QENERAL SANTTATTON <br /> r a �-- <br /> State any problem..s not previously noted: <br /> 3 . EDEULATTON DEYSYTY <br /> Appx. No. People per .aq. mi. <br /> w <br />