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�. SRWAG1 r <br /> Distance to Public Sewers Connection necessary: Yes No._,,,, <br /> Does existing septic system comply with Ord. #548 : - Yea No..,._, <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY � °' �; oe r <S <br /> Is Nater -aupplied. by private"well : Yes6No Is well proper: <br /> Yes State deficiency: <br /> Does exi` ,ting or porposed usemake this well p bl Water: Yes <br /> No Sample of well water taken: Yes No ate taken <br /> Resu is Additional information or comments <br /> 3 . GARRAQE& REFUSS <br /> Licensed scavenger pick-up: Yes— No Service Area No. <br /> Other proposed disposal method: -- <br /> `'' Potential problem: --� <br /> 4. ^COAL <br /> State possible vector potential necessary control: <br /> S. MILE BATH.. "ACILITFr2* <br /> No. & locution existing: Additional <br /> facilities needed <br /> 6. n r, Ot HTSTQRX <br /> .10 <br /> 7 . GENERAL yBANTIA BION <br /> State any problems not previously noted: <br /> $ . POPULATIOU DXNSTTI <br /> Appx. No. People per .an. mi. <br />