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1. SFE <br /> Distance to Public Sewers ^)14 Connection necessary: Yes_ Nom <br /> Does existing septic system comply with Ord. #549 : Yes V,- No_ <br /> Unknown If no, explain: <br /> 73.- //Db 7lo-g7k. <br /> -As 85-1q(vI 77-evr <br /> Describe septic installatt?n to be installed: <br /> Gh.E` <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes �No— Is well proper: <br /> Yes_✓ No_ State deficiency: <br /> Does esting or porposed use make this well public water: Yes <br /> No -i <br /> ample 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 Aethod: <br /> Potential problem: N <br /> 4 . ELL' MOSQUITO OR VZCZOE—ECrUNTIA , <br /> State possible vector potential & necessary control: <br /> 5. TOILET/BATH <br /> No. & location exis g: Additional <br /> facilities needed —_ <br /> 6 . PRFVI011S OPERATION HISTO <br /> 7 . GEN .RA , SANITATION <br /> State any problem^ not previously noted: <br /> s . POPULATION DENSTIX <br /> Appx. No . People per sq. mi . <br />