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1 <br /> Distance to Public Sewers ^� � Connection necessary: Yes_ No— <br /> Does <br /> o'Does existing septic system comply with Ord . #549 : Yes_ No_ <br /> Unknown If no, explain : <br /> A)f ^ �I ac'•e- et"A--e . No <br /> r <br /> Describe septicuinstallation to be install': <br /> 2 . WAT .R SUPPLY <br /> Is water supplied by private well : Yes No_ Is well proper: <br /> Yes No State deficiency : <br /> Does �ist.ing or porposed use make this well public water: Ye <br /> No Sample of well water taken: Yes_ No ✓ Date taken <br /> Results Additional information or comments <br /> NO We(� r neeoGed - KN vw�u.�d �crCt( t,, <br /> 3 . GARBAF & RRPUSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No . <br /> Other proposed disposal method: <br /> Potential problem:- <br /> 4 . F[:Y . MOSQUTTO VinR POTENTIAL <br /> State possible vector potential & necessary control : <br /> S . TOIT, T/BATS PAQUITRa <br /> No. & location existing : ' Additional <br /> facilities needed <br /> 5 . PREVIOUS OPERA ION H Shy <br /> 7 . GENERAL SANTIATTTON <br /> State any problems not prevlously noted: <br /> 9 . PO ULAT-ON PE"LJSITY <br /> Appx. No . People per sq. mi. <br />