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1. S 1XW A G RI <br /> Distance to Public Sewers_ Connection necessary: Yes No_.._ <br /> Does existing 'septic system comply with Ord. 11549 : Yes No..._, <br /> Unknown If no, explain: <br /> . i <br /> Describe septic installation to 'be installed: <br /> i <br /> e I <br /> 2. WATER 5URETaXi <br /> Is water supplied- by private well : Yes No° Is well proper: <br /> Yes No State deficiency: <br /> i <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 & REFUZ <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: ' <br /> Potential problem: <br /> 4 . ELL MOSAU TO OR IUMTO-B POTENTIAL <br /> State possible vector potenti.{Rl necessary control: <br /> 5. TQTT,ET/BATH ,r_,ACTLjTFS <br /> No. & location existing: Additional <br /> facilities needed <br /> s. PHEVTOUS OPSHATTON HTSTORM <br /> 7. GENEBAL SANITATION, <br /> State any problems not Previously noted: <br /> 3 . POPULATION DEN51TY <br /> Appx. No. People per .sq. mi . <br /> i <br /> E <br /> I <br />