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1 • Ed1aWAGF 1 <br /> Distance to Public Sewers --�`" 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 SUPPL`L. <br /> Is water Cupplied b:� private well : Yes ��io Is well proper: <br /> Yes= State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water tarsen: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes �'' Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,_ MOSQUITO OR Vf"T( t' )rMTTA", <br /> State possible vector potentiitl �� necess��r arAtrol :J <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: — Additional <br /> facilities needed _ <br /> 6 . PRFVIOi12 OPERATIONH—=n <br /> 7 . UENERAL SANIT '1�A 'ION <br /> State any problems not previously noted: <br /> 3 . EULIATION DFtaSITY <br /> Appx . No . People per rq. mi . <br />