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SEHAQ i <br /> Distance to Public Sewers Connection necessary: Yes ,- Nok <br /> Does existing septic system comply with Ord. 0549 : YeSNo— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUFPI,Y <br /> Is water supplied by private well: Yes x No Is well proper: <br /> Yes-X- Na State deficiency: <br /> tc <br /> Does existing or porposed Mauve We public udter: Yes <br /> Na Semple of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REF[lSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposamethod: <br /> Potential problem- <br /> 4 . <br /> roblem:4 . FILY-. MQEQUITQ QB VECTOR-Mr-MILL <br /> State possible vector potentifil €z necessary control: <br /> 5 . TOILET/BATH FACIIITES <br /> No . €z location Existing: _ Additional <br /> facilities needed _ <br /> 6 . PREVTOrTa OE A IQaSFX <br /> 7 . GENERAL SAP 'r�N <br /> State any proble:ns not previously noted <br /> 81 P0PULATI011 D Et = <br /> Appx. No . P-E;ople per cq. mi. . <br />