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1. SRWA!3E a <br /> Distance to Public Sewers Connection necessary: Yes No— <br /> Does existing -. septic system comply with Ord. #549 : Ye$ No— <br /> Unknown If no, explain: <br /> Describe septic installation to 'be installed: <br /> t <br /> 2. WATER SUPPLY <br /> Is Nater supplied. by private Well : Yes No Is well proper: <br /> Yes too - 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. A RREUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4 .,. ELY, MOSQUTIQ Q8 Vr,CI!QR PPS}TCNTIAL <br /> State possible vector potentiftl & necessary control: <br /> 5 . TOILET/BATH..CArTLITE.S <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. j',REVTOUE QE!3 2ATInH HISTnRX <br /> 7. QRNERAL SAN7TAT7nN <br /> State any problems not previously noted: . <br /> 8 . p j2ULATION DRUSITY <br /> Apex. No. People per .sq. mi. <br />