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SEWAUX <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 /> a <br /> Describe septic installation to 'be installed: <br /> 2. WATER SUPPLY i <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 - <br /> es_Noms sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE REFUSE <br /> Licensed scavenger pick-up: Yea No Service Area No. <br /> b Other proposed disposal method: <br /> Potential problem: <br /> State possible vector potential necessary control:_ <br /> 5, MILETZDATH <br /> No. & location existing: Additional <br /> facilities needed <br /> 8. BREVIMIS MISBATIM.-HTSTORY. <br /> 7 . QRNEBAL SANTIAZIM <br /> State any problems not previously noted: <br /> APpx. No. People p r .aq. mi. <br />