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1• �Distance to Public Sewers Connection necessary: Yes No.w <br /> ____��. <br /> Does existing septic system comply with Ord, #549 : Yes No— <br /> Unknown It -no, explain: <br /> Describe septic installation to 'be installed: <br /> Is Water supplied. by private Weil: Yes NoIs well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make tizis well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ELL MOSQUIIQ OR VE �• ENITAL <br /> State possible vector potentirtl necessary control: <br /> 5. FACILITES <br /> No. & locution existing: Additional <br /> facilities needed <br /> 6 . PRRYIOUS r, S n <br /> 7 . GENERAL SAJITIATION <br /> State any problems not previously noted: <br /> S . POPULATIQU DENSTIX <br /> APpx. No. People per sq . mi . <br />