Laserfiche WebLink
1 . SEWAGE 7 -ap0 tid <br /> Distance to Public Sewers Connection necessary: Yes_ No_ <br /> Does existing septic system comply with Ord. #549 : 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 : Yes ✓ No_ Is well proper : <br /> Yes_ No State d ficiency : <br /> Does existing or porposed use make this well public water: Yes ✓ <br /> No Sample of well water taken: Yes_ No_ Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & R . [TSE <br /> Licensed scavenger pick-up: Yes_ No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. ELY, MOSQUITO OR Vi''•CTOR_POT HTIA <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVIOUS RATION HISTORY <br /> 7 , GENERAL SANITATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSITY <br /> Appx. No. People per sq. mi ._ <br />