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SCC GltGl ya �M'✓��3 ` „�y s�fr� �✓ /fir/' <br /> 00 <br /> 1 . SEWAGE / / _ <br /> Distance to PubsepticSewers <br /> system complywithConnection <br /> OrdCessary : Yes—#549 : Yes_ No_ <br /> Does existing <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2. WATER SUPPL7 <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes_ No_ State" �d�eficiency: <br /> �X /rum f 0 X <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_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FT.Y. MOSQUITO OR VRCTOR POTENTTAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILFT/BATH FACIU TES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PRFVIOOS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously rioted: <br /> g , PCS U .ATION DENSITY <br /> Appx. No. People per eq. mi . <br />