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1 . SRWAGH <br /> Distance to Public Sewers P , ' . Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord. 11549 : Yes— No, <br /> Unknown If no, explain : <br /> Describe septic installation to be installed: `✓ <br /> 2 . WATER SUPPLY <br /> Is water gypplied by private well : Yes No_ Is well proper: <br /> Yes No_ State deficiency: <br /> A I\A.`F-U a 4'-R/P e' fryryif <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 & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No . <br /> Other proposed disposal method: a <br /> Potential problem: 14 <br /> 4 . ELY , MOSQUITO OR MQTQR POTENTIAL r <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACIT,ITFS <br /> No. & location existing : Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HISTORYX� <br /> �/ r '�I✓U+ �fiY 61r1 C•s' Lir rn [it (.�-� lY/1H r.r ri, <br /> 7 , GENERAL SANITATION <br /> State any problems not previously noted : <br /> 9 . POPULATION DENSITY <br /> Appx . No . People per eq . mi. <br />