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Z . SEWAGE <br /> Distance to Public Sewers .� Connection 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 wa er supplied by private well : .Yes 1� No Is well proper: <br /> Yes No State deficiency : <br /> Does xisting or porposed use make this well public water: Yes <br /> No Sample of well water taken : Yes No Date taken <br /> Resul Additional information or comments <br /> 3 . GARBAGE & _REFUSE 4.1; - <br /> Licensed scavenger pi k-up: Yes No Service Area No . <br /> Other proposed disposal method : <br /> Potential problem: ---- <br /> 4 . <br /> roblem: _4 . FLY, MOSQUITO OR YLsTSLR-EC)r �.N� TIAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILET/BATH FACIL 'II ' <br /> No . & location existing:^ _ Additional <br /> facilities needed-- <br /> 6 . <br /> eeded _6 . PREVIOUS OPERATION HISTORY <br /> 7 . GENERAL SAtUMA ION <br /> State any problems tic t previously rioted : <br /> 3 . POPULATION 12FdJ IT-1 ` <br /> Appx . No . People per eq. mi._���� (f 7 <br />