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w <br /> SEWAU a <br /> Distance o .Public: Sews Is Connection necessary: Yes No_ <br /> Does existing - septic system comply with Ord, 0549 : Yes Not <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> k <br /> 2 i <br /> Is water t;uppl ed. by priv�ite 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 & „RE,ETISR <br /> Licensed scavenger pick-up: Yes No Service Area No, <br /> Other proposed .disposal method: <br /> Potential problem: <br /> 4 . ,. MQSQULTd OR VECTOR PCT ENTIAL <br /> State possible vector potentifil eu necessary control: <br /> 5. MILETZRATH FAGILITEE <br /> No. & locution existing: Additional <br /> facilities needed <br /> 6. E!EEVTQQS O ORY <br /> A22 <br /> 7 . raFNFRAL S,8NTTaTjQH <br /> State any problems not eviously noted : <br /> I <br /> 8 . FQPULA ,IQ14 DELISITY <br /> Appx. No. People per ,a.n. rad. <br /> I <br /> i <br />