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61 36P <br /> �. S �,v / <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. #549 : Yes No_ <br /> Unknown If no, explain• � Tei-,► �r <br /> r <br /> J e.� <br /> sep c nst 4 a on <br /> to "e installed: j <br /> 2. WATER 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 taken: Yea No Date taken <br /> Results Additional information or comments �'✓'✓' r G a T #'O v uie!/ <br /> 3 . QARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FJLY_L MOSQUITO OR VEQTC)R YEfNTTAL <br /> State possible vector potentiFtl & necessary control: <br /> 5 . TQTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIOUS OPERATION HIST <br /> 7 . GENERAL SANIT,gj'j02 <br /> State any problems not previously noted:_ <br /> 8 . EQPULATION DENSITY <br /> Appx. No. People per req. mi. — <br />