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1 . , FWA Q <br /> Distance to Public Sewers Connection necessary: Yes No_ <br /> Does existing septic system comply with Ord. 0549 : Yes No_ <br /> Unknown_ -L.—� If no, explain: // A <br /> Describe septic installation to be installed: y ��� <br /> 2 . {ITER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes... No State deficiency : <br /> Does existing or porposed use make this well public water: Yes— <br /> No---!,,Sample <br /> esNo !,Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem! <br /> 4 . FLY . MOSQUITO OR VECTOR PO'[CNTIAL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOTLET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . PREVTnnS r RRA'"IoN HTSTnRY <br /> 7 . GENERAL SANTIATTON <br /> State any problems not previously noted: <br /> S . POPULATION D .YSTTY '' <br /> Appx. No. People per eq. mi. <br />