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I . SEWACF <br /> Distance to Public Sewers <501 Connection necessary : Yes_, No- <br /> Does existing septic system comply with Ord . $1549 : Yes_ No_ <br /> Unknown— If no, explain: <br /> 4V ryc.tisk <br /> Describe septic installation to be installed: <br /> 2 . WATER S 7PP .Y <br /> Is water supplied by private well : Yes _ No-,2� Is well proper: <br /> Yes_ No_ State deficiency: <br /> Does existing or porposed use make this well public water: Yeses_ <br /> No Sample of well water taken: Yes_ No- <br /> Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & REFOSE <br /> Licensed scavenger pick-up: Yes— No_ Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FLY, MOSQUITO OR VF^TOR POTENTTAL <br /> State possible vector potential & necessary control: <br /> 5 . TOILET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6 . PREVTOOS GPFRATToN HISTORY <br /> 7 . GENERAL SAN TATION <br /> State any problems not previously noted: <br /> 3 . POPULATION DENSTTY <br /> Appx. No . People per eq . mi . <br />