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� .---- <br /> SEWAGE <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: <br /> Describe septic installation to 'be installed: F <br /> E <br /> 2. WATEE 59PELX <br /> Is watek supplied. by private well: Yes iio Is well proper: <br /> Yeso State deficiency: <br /> Does sting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE do REFUSE <br /> Licensed scavenger pick-up: Yes No ervice Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br />! 4• ELY, MOSAULTG OR_VEQT� nR POTENTIAL <br /> State possible vector potential & necessary control: <br /> i <br /> YF <br /> F <br /> 5. Tn LET/ 0TH FACILTTFS <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. EREVIOUS OPERATION HISTORY, <br /> 7. GENERAL, SMITTATICN <br /> State any problems not previously noted: <br /> S . J!QRjILATIQN DENSTTY •— <br /> Appx. No. People per .sq. ni. <br />