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SKWAGE <br /> Distance to Public Sewers to42A,7n 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 . <br /> nstalled:2 . WATER SUITL'L ,� <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 of well water taken: Yes_. No Date taken <br /> Results Additional information or comments <br /> 3 , GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No . <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 . FJ,Y MOS©UTTQ OR yEcTOR POI[ENTTAL <br /> State possible vector potential ecessary control: <br /> 5 . TOTLF.T/BATH FACILITES Additional <br /> No. & location existing: <br /> facilities needed <br /> S . PREVTOnS OPERATTON HISTORY <br /> 22 <br /> .� V` s <br /> 7 . O <br /> State any problems not previouOly noted,/– <br /> g . pQpt)LATIOt; PENSIT:' <br /> A px. No. People per sq. mi• _ - <br />