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Distance to Public Sewers Connection necessary : Yes_ No <br /> Does existing septic system comply with Ord . 33549 : Yes_ No„ <br /> Unknown If no, explain: <br /> L I d car <br /> Describe septic installation to be installed : <br /> Z . WATER SUPPLY <br /> Is water supplied by private well : Yes X No_ Is well proper: <br /> Yes_ No_ State deficiency : <br /> Does existing or porposed use make this we'll public water: Yes <br /> NoSample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSE <br /> tensed scavenger pick-up: Yes No_ Service Ar No . <br /> Ot proposed disposal method : <br /> Poten al problem: <br /> 4 . FLY C L-C)LEETIAL ' <br /> State pasaib vector potential & neee ary central : <br /> 5 . TSJILET/BATH <br /> No. & locatAdditional <br /> facilities needed= <br /> 6 . PREVIOUS OP <br /> 7 . GENERAL SANITAl'10�1 <br /> State any problems not previously no d : <br /> 8 . POPULATION DENSITY <br /> Appx. No. People per sq . mi ._ <br />