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1 . SRWAGE uuK"Dw" <br /> Distance to Public Sewers Connection necessary : Yes_ No� <br /> Does existing septic system comply with Ord . 11549 : Yes_ No_ <br /> Unknown If no, explain: <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : `des No Is well proper: <br /> Yes_ No_ State deficiency : LE f 2e S4e'->S/2d <br /> Does existing or porposed use make this well public water: 'les <br /> No Sample of well water taken: Yes_ No/- Date taken <br /> Results Additional information or comments <br /> 3 , GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes✓ No_ Service Area No. <br /> Other proposed disposal method : <br /> Potential problem : <br /> 4 . FLY , MOSQUITO OR VE.^.TOR POTENTTAL <br /> State possible vector potential & necessary control: <br /> _ EyNsr/�v�r � drti or .�s.nNr Me�5G2u�ry � 5+, <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6. PREVIOUS OPERATToN HTST(1RY <br /> VmP5<- 2,/ <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted : <br /> 9 . POPLIL,ATION Dn^NSTTY <br /> Appx . No . People per an. mi . <br />