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2 05 <br /> 1 <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord. 0549 : Yes_ No_ <br /> Unknown If no , explain: <br /> Describe septic installation to be installed: <br /> 7 ' 2 -73S <br /> 2. HATER SCTl'PL7 <br /> Is wate supplied by private well : Yes C1 Is `i6ll proper: <br /> Yes No_ State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes_ No— Date 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. ELY . MOSQUITO OR ECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. n r, HTSTORX <br /> �K-�cr AW ° <br /> 7 . GENERAL SANITATION <br /> State any problems not Previously noted: <br /> 3 . PnPULATION DENSITY <br /> Appx . No . People per eq. mi . <br />