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SEWAQJ <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: <br /> i <br /> 2. WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No Stade deficiency: <br /> Does existing or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes No Daae taken f <br /> Results Additional information or comments <br /> dM <br /> T � I <br /> e 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. � <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MOS OULT_Q..Ry :CTOR PQ• , <br /> State possible vector potential & necessary control: <br /> . 1 <br /> 5 . TQILFTZBATH rArIL1TE5 <br /> No. & locution exieting: ' Additional <br /> facilities needed <br /> 6 , ovy,.retrT QBEHAITQU HTSTORX <br /> 7 . GENERAL SA2i.ITATIO <br /> State any problems not previ.ously--not-ed: <br /> S . POPULATIQU DENSTTY <br /> APpx, No. People per s3q. mi. <br /> �f <br />