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}.. SEWAGE <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 . NATER SUE214Y <br /> Is water supplied by private well : Yes iso 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 N ervice Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. EI,Y. MOSQUITQ QR VECTOR E0fENTIdLL .. <br /> State possible vector potentiFtl & necessary control : <br /> 5 . Tn LET/BATH FACILITES <br /> No . & location existing: Additional <br /> facilities needed _ <br /> 6 . PREVIO[IS OPERATION HIST=, <br /> r � . <br /> OL <br /> 7 . Qr-,HERAL SAITIT61:1QN <br /> State any problems not previously noted: <br /> Appx. No . People per sq. mi . <br />