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1 . SEF <br /> Distance to Public SewersConnection 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: 4/4'y` <br /> 2. MATER SUPPLY <br /> Is water supplied by private well: Yes V No_ Is well proper: <br /> Yes /_ No_ State deficiency: <br /> Does,existing or porposed use make this 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—,k No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSO TTOISR_yECTOR POTRMTTAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACTUTF.S <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS OPRRATION HISTORY}1 _ ( <br /> VY1�1t� <br /> 7 . GENERAL SAN TATTON <br /> State any problems not previously noted: <br /> 9 . POPULATION nENST7'v <br /> Appx. No. People per sq . mi. <br />