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1 <br /> Distance to Public Sewers Connection necessary : Yes No— <br /> Distance <br /> existing septic system comply with Ord . 0549 : 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 /> 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 & REEUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: _ <br /> 4 . FLY YECTOR POLMMAL <br /> State possible vector potential & necessary control - <br /> 5 . <br /> ontrol :5 . TQ1 - " O 'ES <br /> No . & location exioting : Additional <br /> facilities needed <br /> 6 . ^ fi <br /> 7 . GENERAL SANITA'1IQU <br /> State any problems not previously noted: — <br /> S . <br /> oted: _S . POPULATIO14_DMITY <br /> Appx , No . People per 8q. mi. <br />