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Distance to Public SAI <br /> ewers Connection necessary: Yes No_ <br /> Does existing - septic`. system r comply with Ord. #549 : Yes No <br /> Unknown If, :no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLE <br /> , Is V <br /> supplied. by privAte Well. : Yes No Is well properYesNo State deficiency: <br /> Does existing or pornosed use make tilis well public Water: Yes <br /> No sample of well, water taken: Yes No Date taken <br /> s <br /> ResultAdditional information or comments <br /> 3 . GARAAGE & BET11SE <br /> Licensed° scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method! <br /> Potential problem: <br /> 4. FitY, MOSQUITO QR YM^_•TQR PbTENTIAL <br /> State -possible vector potentials necessary control: <br /> 5. TQTLFT/RATH CArIT:LTHS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. MUMS QEERATTOU HTSTORY, <br /> 7. GENERAL SANTTATZQN- , <br /> State any problems not previously not <br /> 8 . E-OBU A611QH DENS_TTY <br /> Appx, No. People per .aq. mi. <br />