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1. SKWAUS <br /> Distance to Public Sewers Connection necessary: Yes No, <br /> Does existing s6ptic system comply with Ord, #549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> i <br /> 2 . WATER SUPPI,Y <br /> Is Nater supplied. by private well Yes No Is well proper: <br /> Yes No State deficiency: r <br /> i <br /> Does existing or porpoeed 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 & REFUSR <br /> Licenaed scavenger pick-up: Yes Ido Service Area No. <br /> Other proposed disposal method: <br /> Potential problem.- <br /> 4. <br /> roblem:4. ELY, MQSAOITO OR VECTOR EQTENTTAL <br /> State possible vector potential do necessary control: <br /> 5 . TOILF.T/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PREVIORS OPERATION HTS101Y <br /> 7. QUEBAL SAITTTATTON <br /> State any problems not previoualy noted: <br /> Appx. No . People per sq. mi. <br /> i <br />