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Distance to Public Sewers Connection necessary: Yes'' No'— <br /> Does <br /> oDoes existing septic system comply with Ord. #549 : Yes No...._ <br /> Unknown It no, explain: <br /> Describe septic installation to be installed:-- 4c�i sr� ✓ec„ „_. �� �� " <br /> 2. ATER _SUPPLY <br /> Is water supplied by private ;cell : Yes No Is well proper: <br /> Yes No _ State deficiency!--- <br /> Does <br /> eficiency: __._._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. FAY-, _MOSQUITO _QR-VEMM .MOUT.IAL <br /> State possible vector potential & necessary control : <br /> 5 . TQILE .ZBATH FACT <br /> No. & location existing: Additional <br /> facilities needed _ <br /> S . PREVIOUS OPERATION HISTM <br /> 7 . GENERAL-_ SANITAU11 <br /> State any problems not previously noted: - <br /> 8 . <br /> ioted: —S . I'OPULATIOH �STT <br /> Appx. No. People per eq. mi. <br />