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1 . ESEWAGE <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 . WA SUPPLY arsc�A 7♦ ti- ry �'-;,r-, r �., . <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 /> NoSample of well water taken: Yes NoDate taken <br /> Results Additional information or comments TSL r f �- <br /> 3 . GARBAGE & R iTSF °G er <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method : <br /> Potential problem : <br /> 4 . FLY, MQS QUITO QR .YECTQR POTENTIAL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing : Additional <br /> facilities needed <br /> 6 . PREVIOUS OpEgATION HISTORY <br /> AV <br /> 7 . GENERAL SANITATION _ <br /> State any problems not previously noted : — <br /> S . PORU ATION DENSITY <br /> Appx . No . People per sq. mi . <br />