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1 . <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord . #549 : Yes Nom <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes 7X— No Is dell proper: <br /> Yes No State deficiency : <br /> Does existing or porposed use make this well public water: Yes <br /> No—�L Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> REFUSF <br /> Licen d scavenger pick-up: Yes No Service Ar No . <br /> Other pr osed disposal method: <br /> Potential 'i>�oblem: <br /> 4 . FjAj,_ MOSQUITO dj� V 1^TO PQi'fjEZ AL <br /> State possible vlb�tor potentiftl �c -cessary control : <br /> 5 . TO .TT/ ATH FACILITES <br /> No . & location existin _ Additional <br /> facilities needed _ <br /> 6 . PRFVTOQS OPER.ATT ORY <br /> 7 . T ,, �� <br /> State ars problems na t previously noted :- <br /> 8 . <br /> oted :_ <br /> /�pp' <br /> . No . People per sq. mi . <br />