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' SEWAGE V <br /> Distance to' Public Sewers Connection necessary: kst__ <br /> No— <br /> Does existing septic system comply with Ord. #549 : No— <br /> Unknow'n, If no,-.explain! <br /> Describe septic installation to 'be installed: .w .E ... <br /> 4' e '. <br /> i <br /> 2. NATER SUPPLY <br /> Is Hater supplied, by private well: Yes iio �' • Is well 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 & REEUEE <br /> Licenaed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: _ .. <br /> 4. FLY, MQSOOITQ ORM VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TQILET/BATH CACTLITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HISTORY <br /> 7. GENERAL SANITATION <br /> State any problems not previously rioted: <br /> 3 . POEULAITON DFtjSTTv <br /> Appx. No. People per seq. mi. <br /> a <br />