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SEKWAGR <br /> Distance to Public Sewers Connection necessary : Yes— No_ <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPI,'I <br /> 10 <br /> Is water supplied by private well : Yes' No_ Is well proper: <br /> Yes ✓_ State deficiency : <br /> Does existing or porposed use make this well pub water: Yes <br /> — <br /> No maple of well water taken: Yes_ N Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R .FUS . <br /> Licensed scavenger pick-up : Yes_ No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: -�- <br /> 4 . ELY MOSQUITO OR -yzaT0R–z2J'NTTnr, <br /> State possible vector potential & necessary control : <br /> 5 . TO , .T/BATA FACILITES <br /> No . & location existing!- _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OP sRATI N [ALSTo i <br /> 7 . GENERAL SAtITT �1A 'SON <br /> State any problems not previously noted: =—� <br /> 9 . POPU .ATION )Ei ,-:)TT'f <br /> Appx. No . People per sq . mi . <br />