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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . $1549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . 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 t1l.is well public Water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes _NoService Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FILL, MOSQUITO OR V ^.T( MTTMAL <br /> State possible vector potentiftl & necessary control : <br /> 5 . 'COLLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOUS OPERATION HISTORY <br /> 7 . GENERAL 2ANIT,aTj0N <br /> State any problems not previously noted : _ <br /> 3 . POPULATION DE[ `'T X <br /> Appx . No . People per Gq . <br />