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`Y M <br /> 9 f" <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 /> I <br /> 2. WATER SUPPLY <br /> Is water supplied- b_' private 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 & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No...�� <br /> Other proposed disposal method: <br /> Potential. problem: <br /> 4. '�' °� ' <br /> State possible vector potential & necessary control: <br /> 5 . FACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIQnS r, n n <br /> 7 . GENERAL SAJITIATTON <br /> State any problems not previously noted: <br /> $ . t7 T . 51 v <br /> Appx. No. People per .aq. mi. <br />