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q-�` 03 <br /> � �� ► <br /> 1 . SEWAGE <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. $1549 : Yes No_. <br /> Unknown If no, explain: <br /> /IV 26:45, 242 <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is wat supplied by private well : Yes i40Is well proper: <br /> Yes No State deficiency: <br /> Doese sting 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 & REFUSE <br /> Licensed scavenger/pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . =,- M SQU. TQ QR V .T0 EC)M TIAL <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> ML7 . GENERAL SAtU'rATION <br /> State any problems not previously noted: _ <br /> S . M > LATION DENSTly <br /> Apex. No . People per rq. mi . <br />