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er <br /> gam►, ` T z r` '7 ��-- <br /> SEWAGE �- `r ?r <br /> Distance to Public Sewers ection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown If no , explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is watey, supplied by private well : Yes No_ Is well proper: <br /> Yeso_ State deficiency : <br /> Does e sting or porposed use make this well public water: YesrJw ' <br /> NoSample of well water taken : Yes_ No kbate 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 . FLY . MOSQUITO OR VECTOR pi'fENTIAL <br /> State possible vector potentirtl & necessary con s ,l : <br /> 5 . TOI .F.T/BATH FACTLITES <br /> No. & location existing : Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> 'ION <br /> State any problems not previously noted : _ <br /> S . POPULATION DENSITY 'Jv <br /> Appx . No . People per sn , mi . <br />