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w <br /> I. SKWAGF <br /> Distance to Public Sewers Connection necessary: Yes No f <br /> Does existing septic system comply with Ord. 11549 : Yes No✓ <br /> Unknown If no, explain: <br /> Describe septic installatAo to 'be installed: <br /> `To L r, <br /> 2. WATER SUPPLY <br /> Is water ,xppZied. by private well : Yes +-' do Is well proper: <br /> Yes No State deficiency: <br /> Does existing or porposed use make this well pubic water: Yes <br /> No Sample of well water taken: Yes No // Date taken <br /> Results- Additional information or comments <br /> neotiJ we[/ wilt 4.Ue, <br /> i <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposal method: <br /> Potential problem: <br /> 4. FLY, MOSQUTT0 OR VI•QTR PO' <br /> State possible vector pote i & necessary control: <br /> 5. TQTLET/BATH FACILITES <br /> No. & location existing: Additional <br /> facilities needed <br /> 6. PPEVTOna OPERATION HISTORY <br /> 114 c � -- <br /> 7 . GENERAL. SANTTATTON <br /> State any problems not previously need: <br /> S . POPULATION PENSTTY <br /> Appx. No. People per eq. mi. <br />