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1 . SWAGE J <br /> Distance to Public Sewers Connection necessary: Yes No-Z <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 SUPPI2L <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Doe existing or porposed use make this well public water: Yes <br /> NoSample 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, MOSQUITO OR _Y Zi, ) ' MUKl`L`r. AL <br /> State possible vector potentifil & necessary control : <br /> 5 . TQILET/BATH FACI_jj-j'a <br /> No. & location existing: __. Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HIST(a <br /> 7 . GENERAL SANITAZI�U <br /> State any problems not previously noted: ____ <br /> 8 . P E LATIQN = J <br /> Appx . No . People per sq . r%1 -- <br /> _ <br />