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ERWAVa <br /> Distance to Public Sewers ��� Connection necessary: Yes No�, <br /> Does existing septic system comply with Ord. #545 : Yes Now.,, <br /> Unknown If no, explain: <br /> Describe septic installatio to -. e installed: <br /> 2. MATER SUPPLY <br /> Is water supplied. by private well : Yes No � Is well proper: <br /> Yes No State deficiency: <br /> Does existing or pornosed use make this well public crater: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> s . <br /> Licensed scavenger pick-up: Yes �— No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: ° <br /> 4. FLY, MQ50UITO OR VECTOR POTENTIAL <br /> State possible vector potential & necessary control: <br /> 5. TQILFT/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed _ .. ..._ <br /> 6. PRF�VIQU OPERATION HISJOEY <br /> 11 <br /> 7 . QENERAL SANITAITON /J <br /> State any problems not previously noted: r ��1 <br /> $ . PQL'4 TION I3fsN8?'TY A~ <br /> Apex. No. People per eq. mi. <br />