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I • SEWAGE <br /> Distance to Public Sewers ' Connection necessary : Yes No ti <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installati n to 'be installed: <br /> i s«1 <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes �iJo Is crell proper: <br /> Yes f No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No V Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yee No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY , MOSQUITO QR YE TOR PSO'TTNTTAL <br /> State possible vector potential ez necessary control: <br /> 5 . TOTLF.T/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVT0QS OPERATION H STORY <br /> 7 . GENERAL. SANTTATTON <br /> State any problems not previously noted: <br /> 3 . POPULATTON DENSTTY <br /> Appx. No . People per eq . mi. <br />