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MAU <br /> l ` 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 /> s Describe septic installation to 'be installed: <br /> 2. WATER 5gPPLY <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 water: Yes <br /> No— Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments e_X I-STi � <br /> ✓�/�`G,^ -.¢ "r/�, LL """ e <br /> 3 . GARB&QE' & REFUSE I.V 0 �1� �.��► <br /> Aj <br /> Licensed scavenger pick--up: Yes No &ce Area No. <br /> Other proposed disposal I: <br /> Potential problem: <br /> 4 . FLY, Q3QgjTQ OR VECTQR EQ'rrMITAL <br /> State possible vector potential & necessary control: � <br /> 5. TOTLETZBATH Fr ^ <br /> No. & location exioting: _ _ .^ Additional <br /> facilities needed <br /> 6. PREY10ral. r_JURATIOUYH STORY <br /> E <br /> 7 . GENERAL SANITATIM <br /> State any probl me not previocisly noted: <br /> S . POPC3LATI�P� fl�N_�TT� . <br /> Apex. No. People per .sq. mi. <br /> } <br />