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1 . LTi <br /> Distance to Public Sewers `kft Connection necessary : Yes_ NoL <br /> Does existing septic: system comply with Ord . #549 : Yes_ Nom <br /> Unknown If no, explain : <br /> (2f/4*-'v <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes _ No n 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. & REFUSE <br /> Licensed scavenger pick-up: Yes No_ Service Area No. <br /> Other proposed disposal method: ✓IW <br /> Potential problem:__ lALmJ <br /> 4 . FLY, MOSQUITO OR V ^T(M–BCjr'NTIAi, <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILTTRS 1✓C Additional <br /> No. & location existi.r:g: <br /> facilities needed- <br /> 6 . <br /> eeded _6 . PREVTOUS OPERATION HISTORY <br /> 7. GENERAL SAN TATTON N*1P <br /> State any problems not previously noted: <br /> 9 . POPULATION DXNSTTX <br /> Appx . No. People per s7 . mi . ��/' <br />