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o <br /> 7 . <br /> 1 . EjFWAGE <br /> Distance to Public Sewers Connection necessary: Yes No <br /> Does existing septic system comply with Ord . 11549 : Yes No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SU PLIe <br /> �' <br /> Is water- supplied by private well : Yes 4_--44o Is well proper: <br /> Yes � State deficiency: <br /> Does existing or porposed use make- this well public water: Yes <br /> No Semple of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> -" a, 7' ' 2 <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No-,,.— B'arvice Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . ZL�LL MOSQU- TCS QB vE^TO PS�'r TIS <br /> State- possible vector potentiftl necessary control : <br /> 5 . TQILET/BATIT FACILITES <br /> No . & location existing: _ Additional <br /> facilities needed _ <br /> 6 . PWVTaflq OpEgATION HISTngX. <br /> 7 . GENERAL SANI'r '1�N <br /> State any problems riot previouss1-;�, noted:— <br /> S . <br /> oted:_8 . POPULATION DENSITY .�-. <br /> Appx. No . People per rq. mi . <br />