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Distance to Public Sewers _= Connection necessary: Yes No>._ <br /> Does existing septic system comply with Ord . 0549 : Yes No_ <br /> Unknown If no, explain : <br /> Des ribe septic installation to be installed: - i�✓</����i� <br /> 2 . WATER SUPPLY <br /> Is water supplied by private well : Yes No Is well proper: <br /> Yes No State deficiency : <br /> Does i6 ting or porposed use make this well pub is water: Yes <br /> No Sample of well water taken: Yes NoDate taken <br /> Result Additional information or commentsOle <br /> 3 . GARBAGE & REFUSE <br /> Licensed scaven er ick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: , � . ,.�� �9_- - - <br /> 4. FLY MOSQUITQ OR VZ^ O EC)MH11AL <br /> State possible vector potential & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No . & location existing:- Additional <br /> facilities needed <br /> 6 . PREVIOUS O .RATION HI ATOM <br /> 7 . GENERAL SAIJIT `1.1 TION <br /> State any problems not Previously noted : <br /> a . RQPQLATI_ON Dr NSTIy <br /> Appx . No . People per cq . ril . �/�/��✓-ii �/.�F i4��/�'�-� <br />