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} . SHWAra�1 <br /> Distance to Public Sewers Connection necessary: Yens No— . . <br /> Does existing septic sys em comply with Ord. 0549 : Yes No.,,_. <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY <br /> Is w ter 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: Yes2 <br /> No -_-- Sample of well water taken: Yes,_____, No Date taken <br /> Results Additional information or comments <br /> 3 . QARBAGT & _RTFUSF <br /> . Licensed scavenger pick--up: Yes No. Service Area No. <br /> Other proposed disposal method: <br /> Potential problem:F4. LY, MOSAiTITO OR VECTOR., pl' F',N'�IA <br /> . L <br /> State possible vector potential & necessary control:_ <br /> 5, TOILET/BATH-FACILITES <br /> No. & location existing:-_-- . Additional <br /> E facilities needed - -- . . <br /> 6 . PREVIOUS OPERiTION -HISTORY. <br /> 7. GENERAL SANITATIQN <br /> State any problems not previously noted: - - -- <br /> 8. POPULATION-DENSITY <br /> E APPx.. No. People per sq. mi . - -. <br /> E <br />