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Distance to Public Sewers Connection necessary: Yes No— <br /> Doee 'existingseptic system comply with Ord. #549: Yea No— <br /> Unknown I f° no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY <br /> Is water supplied. by private well : Yes Na 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 Na 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. FLY, MOSQUITO OB MIM 20T.H'T <br /> State possible vector potential necessary control: <br /> 5 . TOYLET/HATH FACILITES <br /> No. & Location existing: Additional <br /> facilities needed <br /> 6. EHEVTOR QEERATTON HISIQRX <br /> 7. GENR 3AF,S ANT AITON <br /> State any problems not previously noted: i <br /> ti <br /> 3 . EQ-22LATIQU DENSTTY <br /> Appx. No. People per sq. mi. <br /> 3 <br /> I <br />