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- ' a <br /> Distance to Public Sewers Connection necessary: Yes No_._. <br /> Does existing septic system comply with Ord. 0545 : Yes No_..., <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER 5gpny •- <br /> Is water supplied. by private well: Yes too Is well proper: <br /> Yes NO State deficiency: <br /> Does existing or porposed use make this we'll public water: Yes <br /> No - Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licenced scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSBU.LTQ...Q ECT02 POTENTxtl <br /> State possible vector potential & necessary control: <br /> $ . 191LE.1/86TH FACTLITE5 <br /> No. & location existing: Additional <br /> facilities needed <br /> S . BRUIMS QPERATIOU HTSIngX <br /> 19 <br /> 7 . GENERAL SAHTTATTON <br /> State any problems not previously noted: <br /> 3 . EM)LATTOM DENaUX <br /> Appx. No. People per eq. mi. <br /> 10, ,0 ,s, � 1 <br />