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1 ' Distance <br /> ce to Public Sewers Connection necessary : Yes_ No- <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown If no , explain: AIA- <br /> Describe septic installation to be installed: <br /> 2 . WATER S"PPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yee_ No State deficiency : <br /> Does existing or porposed use make this well public water: Yee / <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 . EIJL MOSQUITO OR V ",7TO PSfGNT-At4 <br /> State possible vector potential & necessary control : <br /> /t/one <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location existing : N� Additional <br /> facilities needed <br /> 6 . PRF.VTOnS OPERATION HISTCIRY <br /> G� <br /> 7 . GENERAL SANIT_A ION <br /> State any problems not prevlouely noted: <br /> 8 . PC)r1jJLATI0N DEMSTTY <br /> Appx. No . People per 6q. mi . <br />