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1 . SEA" +� " <br /> Distance to Public Sewers Connection necessary: Yes Nom;, <br /> Does existing septic system comply with Ord. 0549 : Yeses No" <br /> Unknown If no, explain: , <br /> De crib es pt c installation to''be installed:-fi-� � %-��• <br /> 2 . WATER SUPPLY <br /> Is water supplied. by private well : Yes . No Is w Z1 proper,:r <br /> Yes_ No State deficiency - ZtLle / <br /> Does existing or porposed use make this well public water: Yes <br /> NoL4 Sample of well water taken: Yes , No -><,. Date taken <br /> Results Additi9 al informatipn or comme ts . <br /> 5 y <br /> 3 . <br /> Lice.need 'scavenger pick-up: Yes . No Service Area- No. <br /> Other proposed disposal method:, <br /> Potential problem: <br /> 4 . FLY, MOSQUITO ORVECTQR POTENTIAL <br /> State possible vector potential & necessary control : �� <br /> 5 . TQ1LET/BATH IACTLITES <br /> No. & location existing: fiAdditional <br /> 4 <br /> facilities needed f <br /> 6 . PREY10U$ OPERATION HIST(_78Y .. <br /> 7 . GENtAAL,$A3' ITATION Y <br /> State any problems not previously noted: <br /> 1 r <br /> 8 . RMILATIO11 PEt , <br /> Appx. No. People per ..eq. mi . <br />