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L . SRWA iE <br /> Distance to Public Sewers G `/U connection necessary : Yes_ No_ <br /> Does existing septic system comply with,Jy�rd . #549 : Yes_ No_ <br /> Unknown If no, explain: // <br /> Describe septic installatio to be installed: <br /> d ( )I G �Gtldi�i <br /> 2 . WAM SUPPLY / <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: 'les <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 . F .Y. MOSQUITO OR VrCTOR PO'M.NTIAL <br /> State possible vector potentiril & necessary control: <br /> 5 . TO .ET/BATH FACI .ITF.S <br /> No. ec location existing: Additional <br /> facilities needed <br /> 6. pREVTons OPERATION HISTORY <br /> 7 . GENERAL SANITATION <br /> State any problems not previously noted: <br /> OAS <br /> 9 . POPULATION DENSTTY <br /> Appx. No . People per eq. mi. � `'"¢'` "'�t <br />