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i . SEWAGE <br /> Distance to Public Sewers � Connection necessary: Yes NoX_ <br /> Does existing septic system comply with Ord . $1549 : Yes ( No_ <br /> Unknown Ifno,, explain: <br /> Desc ib e septic ,installat n S o'be installed: <br /> S F67 <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well , Yes Na Is well proper: <br /> Yes. No State deficiency : <br /> n�i <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> R ults 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: 16. '' n ✓ vne e <br /> 4. ELL,_ M0S0UITO Q V EQTC1 R EL)rjjjTIAL <br /> State possible vector potentifil & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. ec location existing: Additional <br /> facilities needed _ <br /> 6 . PERYTOUS OPERATIJON HIST , <br /> 7 . GENERAL SAlITTATION , <br /> State any problem.- riot reviously noted : - <br /> 8 . <br /> oted : -8 . pOPULATT0N IE `'T `' <br /> Appx. No . People per Bq . mi . <br />