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6 <br /> J r SEW <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 /> i <br /> Describe septic installation to 'be installed: <br /> i <br /> Z. WATER SUPPLY <br /> Is water supplied- by private well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public nater: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> i <br /> a . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: j <br /> Potential problem: <br /> i <br /> 4. nEO-CE.NTIAL <br /> State possible vector potential 84 necessary control: <br /> 5 . nEACTLITES <br /> No. & location existing: ' Additional <br /> facilities needed <br /> 6 . PREVTORS OPERATION HISS i <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> 9 , Pn Ui,RTIOt7 D y,TTy <br /> Appx. No . People per eq. mi. <br /> i <br />