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SES <br /> Distance to Public Sewers Connection necessary: Yes Nom" <br /> Does existing septic system comply with Ord. #549 : Yes No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY LA) l ° <br /> Is water supplied by private well: Yest__% No 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 & RRFUSE <br /> Licenced scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:- <br /> 4 . <br /> roblem:4 . FLY, MOSQUITO OR VE^.Tt)Pi'[CNTIAI, <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. VTons opggATToN Hj3jngX <br /> t <br /> 7 . GENERAL SANTIATTON <br /> State any problems not previously noted: <br /> S . POPULATION DENSITY <br /> Appx. No . People per eq. mi. <br /> 01 <br />