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� . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : 'les_ 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 porksed use make this well public water: Yes <br /> No Sample of_y,611 water taken: Yes_ No_ Date taken <br /> Results dditional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed dispose,} method: <br /> Pot%-�-problem: � /Y c J v <br /> 4 . Fr.Y. MOSQUITO OR VZ^.TO ZC)rRNTTAL <br /> State possible vector potential & necessary control: <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PRFVT0Q5 OPRRATTON <br /> 7 . GENERAL SAN TATTON <br /> State any problems not •eviously noted: <br /> 9 . POPULATION DENSITY <br /> Appx. No . People per eq. mi . <br />