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SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> � J <br /> DescrtBe`'dep is instil-118ti.on to 'be insta r±trd: ;t�G"Z'� <br /> Z. WATER SUPPL <br /> Is wate-r supplied by private well : Yes ,tom_ No Is well proper: <br /> Yeso State deficiency: <br /> Does existing or porposed use make this well public Water: Yes <br /> Noi ,-18ample of well water taken: Yes No�/Late 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 . ELY MOSQUITO OR VECTOR PQT2,NTTA <br /> State possible vector, potential & ne a sary control: <br /> r 9r 4, e <br /> rig <br /> 5 . TOILET/BATH <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PRFVIOnS OPERATION HISTORY <br /> 7 . GENERAL. SANTIATTON <br /> State any problems not previously noted: <br /> 8 . popULATION DENSITY <br /> Appx. No . People per sq. mi . <br />