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SEWAGP <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 . WATER SUPPI,I <br /> Is water,- supplied by private well : Yes �No Is well proper: <br /> Yes—.J-.zo State deficiency : <br /> Does ex ting or porposed use make this well Publi water: Yes <br /> No Sample of well water taken: Yes No ate taken________ <br /> Results Additional information or comments�h_e� �.r <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up:--Y4-m� No Service Area No . <br /> Other proposed disposal hod: <br /> Potential problem,: <br /> 4 . FAL MOSQUITO OR VZ;;TQ E2MNTIA1Tj. <br /> State- possible vector potentiftl & necessary control : <br /> 5 . TOILET/BATH FACILITES <br /> No. & location exi ting: _ Additional <br /> facilities needed _ <br /> 6 . PREVIO02 OPER.ATIQU Hn �► r <br /> 7 . GENERAL SAPUL'r 'l�N <br /> State any problems not previously noted: _ <br /> 3 • <br /> POPULATION DEQ, IT! <br /> Appx. No . People per 6q . mi . <br />