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1 . EEWAG <br /> Distance to Public Sewers Connection necessary: Yes N _. <br /> Does existing septic system comply with Ord . #549 : Yes N _. <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUt <br /> Is wa r supplied by private well : Yes. to Is viell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use mal is well public water: Yes <br /> No Semple of well water tat: n: des too Late taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No .ervice Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FAL MOSQUITO OR V ^.TCS E2r :+TiT?A'1U <br /> State- possible vector potentift nF•'_'essary control : <br /> 5 , TOILET/BATH EACILITES <br /> No . & location existing : __ Additional <br /> facilities needed _ <br /> 6 . PREVIOnS OPERATION EEM , <br /> 7 . QFNERAL SAPiI'r,1 ZL(_) <br /> State any problems not previously noted:- <br /> 3 . <br /> oted:_3 . POPULATION DENST11 <br /> Appx. No . People per rq . mi . <br />