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4 <br /> SrKWAU <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 /> o <br /> Describe septic installation <br /> to 'be installed: <br /> 2. WATER SUPPLY <br /> Is Nater supplied. by private well: Yes iso Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public Water: Yes- <br /> No- <br /> esNo - Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE ,& „RETJSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSOUITO OR VECTOR 1' E <br /> State possible vector potential & necessary control: <br /> 5 . TnILFT/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PRFyjona t;PFRATION HiSTc7RX <br /> 7. <br /> State any problems not previously noted: <br /> 8 . POPULATION DRY52TY <br /> Appx. No. People per sq. mi._. - <br />