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Distance to Public Sewers Connection necessary: Yes No�L- <br /> Does existingseptic system comply with Ord. . Yes Nom <br /> Unknown If no, explain: I <br /> Describe septic installation to 'be installed: <br /> s <br /> Z. WATER SUPPLY <br /> Is Water supplied- by private well: Yes No Is well proper: <br /> Yes No State deficiency: <br /> .E <br /> Does xisting or porposed use make t1lis well public crater: Yes <br /> NoSample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> l� <br /> 3 . GARBAGE REFUSE <br /> Licensed scavenger pick--up: Yesv No Service Area No. <br /> Other proposed disposal method. <br /> Potential problem: A eop �. <br /> 4. ELY.-MOSQUITO QJLVMQTOR WrENT16L ' <br /> State possible vector potentiael & necessary control: <br /> M <br /> 5 . n r <br /> No. & location existi.ng:, Additional <br /> facilities needed <br /> t 6. RREVIOUS ORERATIM HISTORY. <br /> 7. GENERAL SANTIATION <br /> ;r <br /> State any problems not previously noted: <br />` <br /> a . k.MLATION DEHZTTY <br /> Appx. No. People per sq. mi. VV <br /> j <br /> 1 <br /> F� <br /> i� <br />