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. SFS Eel <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 /> Describe septic installation to be installed: <br /> 2 . MATER SUPPLY <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 /> 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 No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . L MOSQUITO QR v ZTO EL) E�AL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOTLET/BATH FACILI 'F5 <br /> No. & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PRFVTO(15 OPERATION HISTO r <br /> 7 . GENERAL SA1U `1,A 'I(1N_ <br /> State any problems riot previously noted:- <br /> 8 . <br /> oted:-3 . POPULATION DEt� <br /> Appx. No . People per ccs. m i . �.'- - <br />