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' r <br /> 1 . S •wA , •' -49-4Pd <br /> Distance to Public Sewers 700' <br /> Connection necessary: Yes_ No_ <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 <br /> Is water supplied by private well : Yes _ No_ Is well proper: <br /> Yes_ No_ State deficiency : <br /> Y,�(Jic LAJ, 4.g aJALlttr <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: <br /> Potential problem: <br /> 4 . FLY. M-Q50Uff� VECTOR POTIAL <br /> State possible -vTEN <br /> - Vector potential & necessary control : <br /> 1 <br /> 5 . TQILET/BATH FACILITES <br /> No. & location existing : Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATION HIST: <br /> ii <br /> i <br /> 7 . GENERAL SANITA,j'?ON <br /> State any problems not pre 0L1sly noted: - <br /> 8 . <br /> oted: _8 . POPULATION DENSITY <br /> Appx. No. People per sq . mi. <br />