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.. SRWAr <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 Nater supplied. by privzite well : Yes No Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well public Water: Yes_ <br /> Nom Sample of Well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARAAGE & REFUSF <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY. MOSOM OILVE^.TOR PC1'PCNT1 <br /> State possible vector potentiicl & necessary control: <br /> 5. TOTLETZBATH EACILTTES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. OR --�QE!SRATT0N HISTORY <br /> 7 . GENERAL 5AIIIIATTON <br /> State any problems not previoualy noted: <br /> i <br /> 8 . EDRULATItp, V <br /> Apnx. No. People per .,3q. mi. <br />