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lV e.) <br /> S <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing septic system comply with Ord. #545 : Yes No— <br /> Unknown If' no, explain: <br /> Describe septic installation to 'be installed: <br /> 2. HATER SUPPLY <br /> Is water supplied. by private well : Yes �` No Is well proper: <br /> Yes �Na Y: .. <br /> Does existing or porposed use make this well public Water: Yes <br /> No—Z,--Sample of well water taken: Yes No ate 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. r^TQ PQ' ,,NTTAL <br /> State possible vector potential & necessary control: <br /> 5. TOTLETZBATH t C <br /> LILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. BREV1QM OPERATION HTSIQRX <br /> ` - <br /> 7 . GENERAL SANIJAITOU <br /> State any problems not previously noted : ' <br /> 3 . POBULATTOU DEN TTY <br /> Appx. No. People per .an. mi.— <br /> I <br /> I <br />