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t <br /> G <br /> SKWAGX <br /> Distance to Public Sewers Connection necessary: Yes No__, <br /> Does existing septic system comply with Ord. #549 : Yea No_ <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed:..,- Ifs <br /> 2. WATER S[EELI <br /> Is water supplied. by private well : Yes '— No Is well proper: <br /> Yes No - State deficiency: <br /> Does existing or porposed use make tkzis well public crater: Yes <br /> No Sample of well water taken: Yes No Date taken <br /> Results Additional information or comments <br /> 3 . GARBAGE & BEEUSE <br /> Licensed scavenaer pick-up: Yes No Service Area No.___�._� <br /> Other proposed disposal. method: YJ yvA/ <br /> Potential problem: <br /> 4. FrX. MQ.SQUIIQ OR VECTORF' <br /> State possible vector potentiAl & necessary control: <br /> No. & location existing: Additional <br /> facilities needed <br /> s. PREYTOUS OPER61TON HISIORX <br /> 7. GENEEL,Ax. 5MiLTATTOM l6±' <br /> j State any problems not previously noted: <br /> S . E02ULATION nEH3TTY <br /> Appx. No. People per sq. mi. <br />