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SEWAGE <br /> Distance to Public Sewers Connection necessary : Yes_ No_ <br /> Does existing septic system comply with Ord . 0549 : Yes— No_ <br /> Unknown IIf no, explain: ft <br /> �- <br /> Describe septic installation to be installed: <br /> 2 . WATER SUPPLY <br /> Is wate supply private well : Yes l'�No_ Is well proper: <br /> Yes No_ State deficiency : <br /> Does exi ting or porposed use make this well public water: Yes <br /> No Sample of well water taken: Yes_ No.f,­-bate taken <br /> Results Additional information or comments <br /> w <br /> P <br /> &�"l, C <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem : <br /> 4 . ELL'. MOSQUITO OR VZ:'-T Pc'rLNJJAL <br /> State possible vector potentifil & necessary control : P S ors <br /> 5 . T0TLET/BATH FAQTT TTES <br /> No . & location existing : _ Additional <br /> facilities needed <br /> 6 . PREVIOUS OPERATION HTSTORY <br /> P 7- <br /> 7 . GENERAL SA ITTAl'ION <br /> State any problems not previously noted: _ <br /> S . POPULATION DENSTI:Y <br /> Appx. No . People per sq . mi . <br />