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1 . SKWAQR <br /> Distance to Public Sewers �? 50 Connection necessary: Yes Nom. <br /> Does existing septic system comply with Ord. #549 : Yes= No._._ <br /> Unknowns If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. HAJER SUPE117 <br /> Is water supplied- by private well: Yes 72-0— No Is well proper: <br /> Yes No - State deficiency: <br /> Does a isting or pornosed use make this well public crater: Yes <br /> No Sample of well water taken: Yes No—,L- Date taken <br /> Res lts Additional information or comments <br /> 3 . GARB&GE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MOSQUITO OR ECTOR ' <br /> `State possible vector potential necessary control: <br /> 5. TOILET/BATH FACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HzsTOR.y <br /> 769ANITATIO <br /> State any problems not previously noted: <br /> 3 . POPULATIM DEMIXX <br /> Appx. No. People per .sq. mi. --- -- <br />